Provider Demographics
NPI:1225320054
Name:MEDGROUP MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MEDGROUP MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-250-5600
Mailing Address - Street 1:5200 SW 8TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2300
Mailing Address - Country:US
Mailing Address - Phone:305-250-5600
Mailing Address - Fax:305-250-5688
Practice Address - Street 1:5200 SW 8TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2300
Practice Address - Country:US
Practice Address - Phone:305-250-5600
Practice Address - Fax:305-250-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
FLAHCA HCC 9140261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health