Provider Demographics
NPI:1639561418
Name:METCARE OF FLORIDA
Entity Type:Organization
Organization Name:METCARE OF FLORIDA
Other - Org Name:METCARE OF OKEECHOBEE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2000
Mailing Address - Street 1:6101 BLUE LAGOON DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2055
Mailing Address - Country:US
Mailing Address - Phone:305-500-2114
Mailing Address - Fax:305-370-6024
Practice Address - Street 1:208 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-763-6431
Practice Address - Fax:863-763-2319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMANA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX415AOtherMEDICARE NUMBER