Organization
SOUTH MIAMI MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS M ROLLE OWNER (PRESIDENT)
(305) 807-4871
Entity
Organization
Contact information
Practice address
10740 W FLAGLER ST STE 4, MIAMI, FL 33174-4405
(305) 807-4871
(305) 675-2668
Mailing address
14340 SW 172ND ST, MIAMI, FL 33177-2736
(305) 807-4871
(305) 675-2668
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC
AHCA EXEMPT
FL
Enumeration date
05/10/2018
Last updated
05/10/2018
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