Provider Demographics
NPI:1134388606
Name:MEDLANDS PA INC
Entity type:Organization
Organization Name:MEDLANDS PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YURI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-283-7956
Mailing Address - Street 1:15830 SW 252ND ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2018
Mailing Address - Country:US
Mailing Address - Phone:305-283-7956
Mailing Address - Fax:
Practice Address - Street 1:15830 SW 252ND ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031-2018
Practice Address - Country:US
Practice Address - Phone:305-283-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000187601Medicaid
FLY127NOtherBCBSFL
FL000187601Medicaid