NPIMap

Organization Active NPI

Ebenezer Medical Group Inc

  • Community/Behavioral Health Agency
  • Hialeah, FL
National Provider Identifier
1487249645
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EBENEZER MEDICAL GROUP INC
Practice address
2300 W 84TH St Ste 304
Hialeah, FL 33016-5773
Phone
(786) 666-0590
Fax
(786) 666-0591
NPI assigned
Mar 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Leonel Tomas Santos RodriguezNPI 1649145368
Title
Owner
Phone
(786) 712-8252

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2300 W 84TH St Ste 304
Hialeah, FL 33016-5773

Mailing address

2300 W 84TH St Ste 304
Hialeah, FL 33016-5773
Phone (786) 666-0590

National Provider Directory

National Provider Directory

Locations

2300 W 84th St
Ste 304
Hialeah, FL 33016
Phone (786) 666-0590

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1487249645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 W 84TH ST STE 304",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165773",
            "telephone_number": "786-666-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W 84TH ST STE 304",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165773",
            "telephone_number": "786-666-0590",
            "fax_number": "786-666-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "SANTOS RODRIGUEZ",
        "authorized_official_first_name": "LEONEL",
        "authorized_official_middle_name": "TOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-712-8252"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.