OrganizationIdeal Medical Center Of Hialeah, IncClinic/CenterAmbulatory Health Care FacilitiesPractice Address3805 W 20 Ave Suite 105, Hialeah, FL 33012(305) 557-2277(305) 271-7464PECOS EnrollmentBased on the most recent information from CMS, provider Ideal Medical Center Of Hialeah, Inc 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 yesterday at 12:57 PM.Profile DetailsProvider ID1548359532Provider TypeOrganizationFull NameIdeal Medical Center Of Hialeah, IncSubpartNoEnumeration Date10/11/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address3805 W 20 Ave Suite 105, Hialeah, FL 33012Phone(305) 557-2277FaxUnlisted FaxMailing LocationMailing Address11782 SW 92 Ter, Miami, FL 33186Phone(305) 271-7464FaxUnlisted FaxAuthorized OfficialNameBravo, Octavio Alexis (Coo)Phone(305) 557-2277Provider TaxonomiesCodeDescriptionLicenseCode261QH0100XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseHCC6717Florida