Provider Demographics
NPI:1578847638
Name:PREFERRED CARE PARTNERS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PREFERRED CARE PARTNERS MEDICAL GROUP, INC.
Other - Org Name:PREFERRED CARE PARTNERS MEDICAL GROUP OF RED ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARUNCHO
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:305-670-8440
Mailing Address - Street 1:PO BOX 566538
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6538
Mailing Address - Country:US
Mailing Address - Phone:305-260-2680
Mailing Address - Fax:305-260-2606
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3275
Practice Address - Country:US
Practice Address - Phone:305-260-2680
Practice Address - Fax:305-260-2606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED CARE PARTNERS MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty