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Public Health Trust of Dade County Florida

Organization Active NPI Maternal & Fetal Medicine Physician · Miami, FL

NPI 1104585876 · NPPES record last updated Feb 25, 2022

Key facts

NPI
1104585876
Entity type
Organization (NPI type 2)
Primary specialty
Maternal & Fetal Medicine Physician 207VM0101X
Legal business name
PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Practice address
11760 SW 40TH St Ste 646
Miami, FL 33175-8103
Phone
(786) 466-8480
NPI assigned
Dec 10, 2021
Organization subpart
No

Authorized official

Name
Mark T Knight, CFO
Title
Executive VP, Cfo
Phone
(305) 585-8490

Corporate family (same tax ID) 32

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

View all 32

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2218638JMG Specialty Physicians
11760 SW 40TH St - #646, Miami, FL 33175		Certificate of waiverMar 29, 2027

National Provider Directory

Tax ID family
Jackson Medical Group Plan (33 organizations share this tax ID)

Locations

11760 SW 40th St
Ste 646
Miami, FL 33175
Phone (305) 552-5354

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207VM0101X Yes

Addresses

Primary practice location

11760 SW 40TH St Ste 646
Miami, FL 33175-8103

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (305) 585-5315

Other identifiers

IdentifierTypeStateIssuer
108699900MedicaidFL

Other names

  • JMG Specialty Physicians Doing business as

Other providers in Miami, FL

All providers in Miami, FL · Maternal & Fetal Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.