Provider Demographics
NPI:1497756712
Name:G4 MEDICAL CENTERS, INC
Entity Type:Organization
Organization Name:G4 MEDICAL CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-229-0900
Mailing Address - Street 1:2821 E COMMERCIAL BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4216
Mailing Address - Country:US
Mailing Address - Phone:954-229-0204
Mailing Address - Fax:
Practice Address - Street 1:2821 E COMMERCIAL BLVD
Practice Address - Street 2:STE 201
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4216
Practice Address - Country:US
Practice Address - Phone:954-229-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1143332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9700OtherBC BS OF FL
PR75804GMOtherTRIPLE S BC/BS OF P.R.
FL0696390001Medicare NSC