Provider Demographics
NPI:1225731102
Name:CAREMAX MEDICAL CENTERS OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:CAREMAX MEDICAL CENTERS OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RA
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-8100
Mailing Address - Street 1:11250 SW VILLAGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987
Mailing Address - Country:US
Mailing Address - Phone:772-874-3217
Mailing Address - Fax:772-874-3227
Practice Address - Street 1:11250 SW VILLAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:772-874-3217
Practice Address - Fax:772-874-3227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREMAX MEDICAL CENTERS OF CENTRAL FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center