Provider Demographics
NPI:1235532375
Name:CNAG, INC
Entity Type:Organization
Organization Name:CNAG, INC
Other - Org Name:MEDICAL DOCTORS HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-526-0840
Mailing Address - Street 1:400 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6269
Mailing Address - Country:US
Mailing Address - Phone:954-526-0840
Mailing Address - Fax:954-526-0683
Practice Address - Street 1:400 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6269
Practice Address - Country:US
Practice Address - Phone:954-526-0840
Practice Address - Fax:954-526-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78770364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264910101Medicaid
FL264910101Medicaid
FLAD564Medicare PIN