Provider Demographics
NPI:1255662813
Name:MD CARE, LLC
Entity Type:Organization
Organization Name:MD CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QING
Authorized Official - Middle Name:LU
Authorized Official - Last Name:MCGAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-418-2733
Mailing Address - Street 1:11936 MANDEVILLA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3305
Mailing Address - Country:US
Mailing Address - Phone:813-908-2273
Mailing Address - Fax:813-908-2275
Practice Address - Street 1:13036 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2808
Practice Address - Country:US
Practice Address - Phone:813-908-2273
Practice Address - Fax:813-908-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98949261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279502700Medicaid
FL279502700Medicaid