Organization
JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Active
Other names
Jessie Trice Community Health Center Inc, JTCHS Fatima Zafar MD Health Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN R. HAWKINS (PRESIDENT & CEO)
(305) 805-1700
Entity
Organization
Contact information
Practice address
5361 NW 22ND AVE, MIAMI, FL 33142-8035
(305) 637-6400
(305) 636-5155
Mailing address
5607 NW 27TH AVE, SUITE 1, MIAMI, FL 33142-2826
(305) 805-1700
(305) 805-1715
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
5143177
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029541800
—
FL
05
—
029541801
—
FL
05
—
053833700
—
FL
05
—
060826200
—
FL
Enumeration date
07/05/2006
Last updated
11/26/2024
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