Look up the most recent NPI and PECOS records

Jackson Memorial Hospital

General Acute Care Hospital

Hospitals

PECOS Enrollment

Based on the most recent information from CMS, provider Jackson Memorial Hospital does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 15 days ago.

Profile Details

Provider ID
1184781452
Provider Type
Organization
Full Name
Jackson Memorial Hospital

Subpart
No
Enumeration Date
1/3/2007
Last Updated
7/24/2008

Contact Information

Practice Location

1611 NW 12th Ave, Miami, FL 33136-1005

(305) 585-5109

Unlisted Fax

Mailing Location

1350 Pelican Ct, Homestead, FL 33035-1031

(305) 245-3909

Unlisted Fax

Authorized Official

Beck, Karen S (Arnp)

(305) 585-5109

Provider Taxonomies

Code	Description	License
Code 282N00000X Primary	Description General Acute Care Hospital Hospitals	License 76214-2 Florida

Provider Identifiers

ID	Description	Issuer
ID 304053400	Description Medicaid	Issuer Unlisted Florida

Jackson Memorial Hospital

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Hibi, Taizo

Public Health Trust Of Miami Dade County Florida

University Of Miami

Public Health Trust Of Miami Dade County Florida

University Of Miami

Jackson Memorial Hospital

Jackson Memorial Hospital

Jackson Mem Hos

Berger, Ting

Moss, Stephanie R.