| Altius Medical Center Llc | |
|
14221 Sw 120th St Ste 129 Miami FL 33186-7463 | |
| (786) 292-9650 | |
| (786) 420-3240 |
| Full Name | Altius Medical Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 14221 Sw 120th St Ste 129, Miami, Florida |
| Authorized Official Name and Position | Alian Hernandez Lopez (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3059885000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altius Medical Center Llc 14221 Sw 120th St Ste 129 Miami FL 33186-7463 Ph: (786) 292-9650 | Altius Medical Center Llc 14221 Sw 120th St Ste 129 Miami FL 33186-7463 Ph: (786) 292-9650 |
| NPI Number | 1770204141 |
|---|---|
| Provider Enumeration Date | 09/06/2022 |
| Last Update Date | 08/29/2024 |
| Medicare PECOS PAC ID | 8426424854 |
|---|---|
| Medicare Enrollment ID | O20221026000919 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770204141 | NPI | - | NPPES |
| ID | Other | FL | 55555 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Alian Hernandez Lopez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1710333596 PECOS PAC ID: 1355778184 Enrollment ID: I20220827000475 |
| Provider Name | Roberto Reyes Nieves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992303101 PECOS PAC ID: 4880060219 Enrollment ID: I20230329000206 |
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