Basic Information
| Provider Information | |||||||||
| NPI: | 1881133908 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METCARE OF FLORIDA INC, | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | METCARE OF SOUTH DAYTONA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 BLUE LAGOON DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331262055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865523143 | ||||||||
| FaxNumber: | 3053706024 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 BEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321191823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867608116 | ||||||||
| FaxNumber: | 3867600532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2017 | ||||||||
| LastUpdateDate: | 07/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | ROSELLO | ||||||||
| AuthorizedOfficialFirstName: | GEMMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 3055002109 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METCARE OF FLORIDA INC, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.