Phoenix Clinic, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

1113AD081801 Issued in FL

Legal business name

PHOENIX CLINIC, INC.

Practice address

13730 NW 6TH CT
North Miami, FL 33168-2931

Phone

(305) 891-3439

NPI assigned

Oct 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bonnie Graham

Title

Chief Executive Officer

Phone

(305) 891-3439

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Phoenix Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Phoenix Clinic, Inc.

  • Clinic Pharmacy
  • North Miami, FL
  • NPI 1760673503
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1043304140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13730 NW 6TH CT",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331682931",
            "telephone_number": "305-891-3439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13730 NW 6TH CT",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331682931",
            "telephone_number": "305-891-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-891-3439"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "1113AD081801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE LICENSE",
            "identifier": "1113AD081801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene Pesant, LCSW
• PG of Miami LLC
• Pharma Source DME,Inc
• Majerry Philius, PA-C
• Keegan Phillips
• Phoenix Clinic, Inc.
• Physical Therapy Experts Inc
• Physician Access Group, LLC
• Physician Access Urgent Care Group, LLC
• Physicians Group of South Florida PA

• Mental Health Clinic/Center (Including Community Mental Health Center) in North Miami, FL
• Providers in North Miami, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.