Provider Demographics
NPI:1225193758
Name:MANAGED CARE OF NORTH AMERICA
Entity Type:Organization
Organization Name:MANAGED CARE OF NORTH AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-730-7131
Mailing Address - Street 1:3230 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3230 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3429
Practice Address - Country:US
Practice Address - Phone:954-730-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076519800Medicaid