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Public Health Trust of Miami Dade County Florida

Organization Active NPI Community/Retail Pharmacy · Doral, FL

NPI 1730767971 · NPPES record last updated Mar 30, 2021

Key facts

NPI
1730767971
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Practice address
2801 NW 79TH Ave
Doral, FL 33122-1174
Phone
(786) 466-1010
NPI assigned
Mar 30, 2021
Organization subpart
No

Authorized official

Name
Mark T Knight
Title
Evp Cfo
Phone
(305) 585-7979

Owned or controlled facilities with NPI records 25

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 20

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Public Health Trust of Miami Dade County Florida
Miami, FL · CCN 100022		 Hospital Operational/Managerial Control (100%) Oct 1, 1973
Jackson Memorial Long Term Care Center
Miami, FL · CCN 105392		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 25, 1992
Apr 25, 1992
May 5, 2025
Public Health Trust of Miami Dade County Florida
Cutler Bay, FL · CCN 105252		 Skilled nursing facility 5% Or Greater Direct Ownership Interest
Operational/Managerial Control
Adp of the SNF		 Oct 1, 1973
Oct 1, 1973
Oct 1, 1973

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20211119001781 FL DME Supplier - Pharmacy 8628981925 Practice locations: Doral, FL

National Provider Directory

Tax ID family
Dianne M Parker MD (54 organizations share this tax ID)

Networks

  • HealthSun Health Plans Network

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Yes

Addresses

Primary practice location

2801 NW 79TH Ave
Doral, FL 33122-1174

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8101

Other names

  • Jackson Pharmacy -West -52081 Doing business as

Other providers in Doral, FL

All providers in Doral, FL · Community/Retail Pharmacy in Florida

Sources for this page

Verify at the official NPI Registry.