Provider Demographics
NPI:1396002929
Name:FLORIDA MEDICAL CENTER GROUP, INC.
Entity Type:Organization
Organization Name:FLORIDA MEDICAL CENTER GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-378-8200
Mailing Address - Street 1:1501 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5559
Mailing Address - Country:US
Mailing Address - Phone:786-378-8200
Mailing Address - Fax:305-907-5299
Practice Address - Street 1:1501 NW 36 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-9998
Practice Address - Country:US
Practice Address - Phone:786-378-8200
Practice Address - Fax:305-907-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty