Provider Demographics
NPI:1174995609
Name:PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI
Entity type:Organization
Organization Name:PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-290-9192
Mailing Address - Street 1:13205 SW 137TH AVE # 224-225
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5331
Mailing Address - Country:US
Mailing Address - Phone:786-290-9192
Mailing Address - Fax:786-603-8893
Practice Address - Street 1:13205 SW 137TH AVE STE 232-233
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5331
Practice Address - Country:US
Practice Address - Phone:786-290-9192
Practice Address - Fax:800-603-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 251B00000X, 251S00000X, 261QM0850X
FLARNP9231287261QH0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841694221OtherNPI (PERSONAL)
FL016803600Medicaid
FL1174995609OtherNPI