Provider Demographics
NPI:1780959650
Name:HAMMOCKS TRAUMA CENTER, INC
Entity type:Organization
Organization Name:HAMMOCKS TRAUMA CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENTE
Authorized Official - Phone:786-703-1504
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD STE 1C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7012
Mailing Address - Country:US
Mailing Address - Phone:786-703-1504
Mailing Address - Fax:786-703-1504
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7012
Practice Address - Country:US
Practice Address - Phone:786-703-1504
Practice Address - Fax:786-703-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0208X, 261QP2000X, 261QX0100X, 261QR0400X, 261QP2300X
FLHCC3663261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care