Provider Demographics
NPI:1780757625
Name:COMMUNITY HEALTH OF SOUTH DADE
Entity type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH DADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOFAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-242-6040
Mailing Address - Street 1:14139 SW 146TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7206
Mailing Address - Country:US
Mailing Address - Phone:305-234-6526
Mailing Address - Fax:305-245-1161
Practice Address - Street 1:810 W MOWRY DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5746
Practice Address - Country:US
Practice Address - Phone:305-242-6040
Practice Address - Fax:305-245-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84978261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care