Provider Demographics
NPI:1487984365
Name:LITE LLC
Entity type:Organization
Organization Name:LITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-595-4681
Mailing Address - Street 1:8603 S DIXIE HWY
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7807
Mailing Address - Country:US
Mailing Address - Phone:305-595-4681
Mailing Address - Fax:305-273-9584
Practice Address - Street 1:8603 S DIXIE HWY
Practice Address - Street 2:SUITE 411
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7807
Practice Address - Country:US
Practice Address - Phone:305-595-4681
Practice Address - Fax:305-273-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26578261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60055Medicare UPIN