Provider Demographics
NPI:1053647784
Name:MED ONE HEALTH CARE GROUP LLC
Entity Type:Organization
Organization Name:MED ONE HEALTH CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRIED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBISU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-381-5301
Mailing Address - Street 1:2387 W 68TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6889
Mailing Address - Country:US
Mailing Address - Phone:305-381-5301
Mailing Address - Fax:305-381-5541
Practice Address - Street 1:2387 W 68TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6889
Practice Address - Country:US
Practice Address - Phone:305-381-5301
Practice Address - Fax:305-381-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty