Provider Demographics
NPI:1619584521
Name:MEDGROUP MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MEDGROUP MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-761-6685
Mailing Address - Street 1:2150 W 68TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1802
Mailing Address - Country:US
Mailing Address - Phone:305-854-4443
Mailing Address - Fax:
Practice Address - Street 1:2150 W 68TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1802
Practice Address - Country:US
Practice Address - Phone:305-854-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center