Provider Demographics
NPI:1548567191
Name:FAITH MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:FAITH MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHATARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES-MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-685-8001
Mailing Address - Street 1:845 NW 119TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2336
Mailing Address - Country:US
Mailing Address - Phone:305-685-8001
Mailing Address - Fax:305-685-8024
Practice Address - Street 1:845 NW 119TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2336
Practice Address - Country:US
Practice Address - Phone:305-685-8001
Practice Address - Fax:305-685-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty