JACKSON MEMORIAL HOSPITAL PEDI RENAL – NPI #1386714418
Clinic/Center

JACKSON MEMORIAL HOSPITAL PEDI RENAL is an AHC clinic located in MIAMI, FL. NPPES has assigned the NPI number 1386714418 to JACKSON MEMORIAL HOSPITAL PEDI RENAL on November 08, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “JACKSON MEMORIAL HOSPITAL PEDI RENAL” is a dba name, the actual legal business name for this organization is PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA. The primary taxonomy selected by this provider is 261QE0700X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment

The NPI profile was previously updated about 9 years ago on Apr 06, 2017. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for JACKSON MEMORIAL HOSPITAL PEDI RENAL below.

NPI Profile for
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

NPI Number
1386714418
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Doing Business As (dba): JACKSON MEMORIAL HOSPITAL PEDI RENAL
Primary location
1611 NW 12TH STREET
MIAMI, FL 33136-1005
Phone: (305) 585-8490 Fax: (305) 355-2377
Mailing address
PO BOX 12493
MIAMI, FL 33101-2493
Phone: (786) 466-8080 Fax: (305) 355-5380
Organization Subpart
Yes - JACKSON MEMORIAL HOSPITAL PEDI RENAL is subpart of another organization.
Authorized Official
MARK KNIGHT
CHIEF FINANCIAL OFFICER
Phone: (305) 585-7979
Updated
Identifiers

Identifiers for JACKSON MEMORIAL HOSPITAL PEDI RENAL

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDFL010042100
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QE0700X
- Clinic/Center / End-Stage Renal Disease (ESRD) Treatment (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.