Basic Information
| Provider Information | |||||||||
| NPI: | 1942812763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARBON HEALTH MEDICAL GROUP OF FLORIDA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 PACIFIC AVE # 101 | ||||||||
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| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941112009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152002133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4825 SW 148TH AVE | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333302129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152002133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILES | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | HEAD OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7758137777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.