OrganizationJackson Memorial HospitalGeneral Acute Care HospitalHospitalsPractice Address1611 NW 12th Ave, Miami, FL 33136-1005(305) 585-6334(305) 535-9962PECOS EnrollmentBased on the most recent information from CMS, provider Jackson Memorial Hospital does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 15 days ago.Profile DetailsProvider ID1336152073Provider TypeOrganizationFull NameJackson Memorial HospitalSubpartNoEnumeration Date8/14/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address1611 NW 12th Ave, Miami, FL 33136-1005Phone(305) 585-6334FaxUnlisted FaxMailing LocationMailing Address1621 Collins Ave Apt 903, Miami Beach, FL 33139-3142Phone(305) 535-9962FaxUnlisted FaxAuthorized OfficialNameMena, Lynette C (Physical Therapist)Phone(305) 535-9962Provider TaxonomiesCodeDescriptionLicenseCode282N00000XPrimaryDescriptionGeneral Acute Care HospitalHospitalsLicense20652Florida