Provider Demographics
NPI:1386686749
Name:MED - CARE CLINIC INC
Entity Type:Organization
Organization Name:MED - CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-1622
Mailing Address - Street 1:735 NW 22ND AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3339
Mailing Address - Country:US
Mailing Address - Phone:305-642-1622
Mailing Address - Fax:305-642-1197
Practice Address - Street 1:735 NW 22ND AVE
Practice Address - Street 2:UNIT A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3339
Practice Address - Country:US
Practice Address - Phone:305-642-1622
Practice Address - Fax:305-642-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0109Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER