Active NPI
125TH Street NM Corp
- Addiction Psychiatry Physician
- North Miami, FL
National Provider Identifier
1619352283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Psychiatry Physician
- Legal business name
- 125TH STREET NM CORP
- Practice address
- 505 NE 125TH St
North Miami, FL 33161-4718 - Phone
- (954) 271-0485
- NPI assigned
- Jul 24, 2015
- Last updated
- Apr 7, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Renee Douthat
- Title
- Cdo
- Phone
- (954) 271-0485
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | PMC20 | FL | |
| Specialist | 174400000X | |||
| Addiction Psychiatry Physician | 2084P0802X | Primary |
Addresses
Primary practice location
505 NE 125TH St
North Miami, FL 33161-4718
Mailing address
505 NE 125TH St
North Miami, FL 33161-4718
Phone (954) 271-0485
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HCC8934 | Other | FL | ACHA |
National Provider Directory
National Provider Directory- Tax ID family
- 125TH Street NM Corp
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Multi-Specialty Clinic/Center
- North Miami, FL
- NPI 1255633046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459987200000",
"number": "1619352283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 NE 125TH ST",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331614718",
"telephone_number": "954-271-0485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 NE 125TH ST",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331614718",
"telephone_number": "954-271-0485"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "125TH STREET NM CORP",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-24",
"last_updated": "2016-04-07",
"status": "A",
"authorized_official_last_name": "DOUTHAT",
"authorized_official_first_name": "RENEE",
"authorized_official_title_or_position": "CDO",
"authorized_official_telephone_number": "954-271-0485"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "FL",
"license": "PMC20",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACHA",
"identifier": "HCC8934",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.