Unified Medical LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

UNIFIED MEDICAL LLC

Practice address

15495 Eagle Nest LN Ste 130
Miami Lakes, FL 33014-2242

Phone

(305) 330-5510

NPI assigned

Mar 22, 2020

Organization subpart

No

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

Authorized official

Name

Trevor Felicetti

Title

Owner

Phone

(212) 297-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1584835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584835200000",
    "number": "1881220747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15495 EAGLE NEST LN STE 130",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330142242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15495 EAGLE NEST LN STE 130",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330142242",
            "telephone_number": "305-330-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIFIED MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-22",
        "last_updated": "2020-03-22",
        "certification_date": "2020-03-22",
        "status": "A",
        "authorized_official_last_name": "FELICETTI",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-297-2000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA AHCA",
            "identifier": "HCC12128",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "trevor@promedimg.com",
            "affiliation": "N",
            "address_1": "15495 Eagle Nest Ln Ste 130",
            "city": "Miami Lakes",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330142242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinic/Center in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2020; 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.