Provider Demographics
NPI:1053581587
Name:CENTRO MIDWAY AMNISTIA Y MEDICO
Entity type:Organization
Organization Name:CENTRO MIDWAY AMNISTIA Y MEDICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PADRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-267-0744
Mailing Address - Street 1:85 GRAND CANAL DR STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2566
Mailing Address - Country:US
Mailing Address - Phone:305-267-0744
Mailing Address - Fax:305-267-0755
Practice Address - Street 1:85 GRAND CANAL DR STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2566
Practice Address - Country:US
Practice Address - Phone:305-267-0744
Practice Address - Fax:305-267-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50431261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7419Medicare UPIN