Basic Information
| Provider Information | |||||||||
| NPI: | 1922443407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR MEDICAL CARE GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11760 SW 40TH ST | ||||||||
| Address2: | SUITE 616 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054010441 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Practice Location | |||||||||
| Address1: | 11760 SW 40TH ST | ||||||||
| Address2: | SUITE 616 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054010441 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | MELGAR | ||||||||
| AuthorizedOfficialFirstName: | ALFREDO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MNG | ||||||||
| AuthorizedOfficialTelephone: | 3054010441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME1027962 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.