Provider Demographics
NPI:1396379426
Name:ST GEORGE HEALTH PARTNERS CORP
Entity Type:Organization
Organization Name:ST GEORGE HEALTH PARTNERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELCORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-446-6316
Mailing Address - Street 1:434 SW 12TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2432
Mailing Address - Country:US
Mailing Address - Phone:786-860-5156
Mailing Address - Fax:
Practice Address - Street 1:434 SW 12TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2432
Practice Address - Country:US
Practice Address - Phone:786-860-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty