Provider Demographics
NPI:1437733375
Name:M&G HEALTH CENTER LLC
Entity Type:Organization
Organization Name:M&G HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOGINE
Authorized Official - Middle Name:CHERENFANT
Authorized Official - Last Name:DORISCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-296-9451
Mailing Address - Street 1:6273 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1343
Mailing Address - Country:US
Mailing Address - Phone:954-296-9451
Mailing Address - Fax:
Practice Address - Street 1:6273 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1343
Practice Address - Country:US
Practice Address - Phone:954-296-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service