Basic Information
| Provider Information | |||||||||
| NPI: | 1306166046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN CARE OF SOUTH FLORIDA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11255 SW 211TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331892240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
| FaxNumber: | 7862350145 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 PEMBROKE RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330232216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549617100 | ||||||||
| FaxNumber: | 9549626600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3052780200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME53888 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | ME53888 | 01 | FL | MEDICAL LICENSE | OTHER | 062267200 | 05 | FL | MEDICAID |