Provider Demographics
NPI:1730943614
Name:SOUTH BEACH MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTH BEACH MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-874-3365
Mailing Address - Street 1:2100 SE OCEAN BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3332
Mailing Address - Country:US
Mailing Address - Phone:772-252-5265
Mailing Address - Fax:772-874-3115
Practice Address - Street 1:2100 SE OCEAN BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-252-5265
Practice Address - Fax:772-874-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty