Sport Medical Center Corp

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

HCC9156 Issued in FL

Legal business name

SPORT MEDICAL CENTER CORP

Practice address

6501 NW 36TH St
Ste 302
Virginia Gardens, FL 33166-6959

Phone

(305) 526-1599

Fax

(305) 526-1699

NPI assigned

May 13, 2011

Organization subpart

No

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

Authorized official

Name

Hisela Castro

Title

President

Phone

(305) 526-1599

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1235421876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 NW 36TH ST",
            "address_2": "STE 302",
            "city": "VIRGINIA GARDENS",
            "state": "FL",
            "postal_code": "331666959",
            "telephone_number": "305-526-1599",
            "fax_number": "305-526-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 NW 36TH ST",
            "address_2": "STE 302",
            "city": "VIRGINIA GARDENS",
            "state": "FL",
            "postal_code": "331666959",
            "telephone_number": "305-526-1599",
            "fax_number": "305-526-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT MEDICAL CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "CASTRO",
        "authorized_official_first_name": "HISELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-526-1599"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "HCC9156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Virginia Gardens, FL
• Providers in Virginia Gardens, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; 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.