| Ssld Group Corp | |
|
4789 Nw 167th St Miami Gardens FL 33055-4242 | |
| (305) 413-3863 | |
| Not Available |
| Full Name | Ssld Group Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 4789 Nw 167th St, Miami Gardens, Florida |
| Authorized Official Name and Position | Surafel Kebede Gebreselassie (PRESIDENT) |
| Authorized Official Contact | 3054133863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssld Group Corp 4789 Nw 167th St Miami Gardens FL 33055-4242 | Ssld Group Corp 4789 Nw 167th St Miami Gardens FL 33055-4242 Ph: (305) 413-3863 |
| NPI Number | 1154207678 |
|---|---|
| Provider Enumeration Date | 08/12/2025 |
| Last Update Date | 08/12/2025 |
| Certification Date | 08/12/2025 |
| Medicare PECOS PAC ID | 1456854397 |
|---|---|
| Medicare Enrollment ID | O20250915002479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154207678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Surafel K Gebreselassie |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1912170713 PECOS PAC ID: 3173698073 Enrollment ID: I20150407000445 |
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