Provider Demographics
NPI:1487665642
Name:HEALTHCARE AMERICA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:HEALTHCARE AMERICA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WERTHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCIALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-752-2700
Mailing Address - Street 1:3501 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3104
Mailing Address - Country:US
Mailing Address - Phone:941-752-2700
Mailing Address - Fax:941-752-2730
Practice Address - Street 1:3501 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3104
Practice Address - Country:US
Practice Address - Phone:941-752-2700
Practice Address - Fax:941-752-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376937200Medicaid
FL376937200Medicaid
1069350001Medicare NSC