| Martin Luther King & Martin Luther King Ucc | |
|
810 W Mowry Dr Homestead FL 33030-5746 | |
| (305) 248-4334 | |
| Not Available |
| Full Name | Martin Luther King & Martin Luther King Ucc |
|---|---|
| Speciality | Clinic/Center |
| Location | 810 W Mowry Dr, Homestead, Florida |
| Authorized Official Name and Position | Brodes H. Hartley (PRESIDENT/CEO) |
| Authorized Official Contact | 3052535100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Luther King & Martin Luther King Ucc 10300 Sw 216th St Miami FL 33190-1003 Ph: (305) 253-5100 | Martin Luther King & Martin Luther King Ucc 810 W Mowry Dr Homestead FL 33030-5746 Ph: (305) 248-4334 |
| NPI Number | 1821251331 |
|---|---|
| Provider Enumeration Date | 07/03/2008 |
| Last Update Date | 04/17/2013 |
| Medicare PECOS PAC ID | 6507770526 |
|---|---|
| Medicare Enrollment ID | O20040726000575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821251331 | NPI | - | NPPES |
| 029572801 | Medicaid | FL | |
| 060303105 | Medicaid | FL | |
| 051423300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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