Provider Demographics
NPI: | 1033770524 |
---|---|
Name: | ONE CARE MEDICAL CENTER INC |
Entity Type: | Organization |
Organization Name: | ONE CARE MEDICAL CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDERSON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHAVEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-200-3488 |
Mailing Address - Street 1: | 7171 SW 24TH ST STE 417 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33155-1693 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-200-3488 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7171 SW 24TH ST STE 417 |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33155-1693 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-200-3488 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-06-25 |
Last Update Date: | 2024-05-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |