Provider Demographics
NPI:1639679715
Name:ESSENTIAL MEDICAL CARE LLC
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-384-8624
Mailing Address - Street 1:1825 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3683
Mailing Address - Country:US
Mailing Address - Phone:754-227-6117
Mailing Address - Fax:754-300-3262
Practice Address - Street 1:9611 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4030
Practice Address - Country:US
Practice Address - Phone:754-227-6117
Practice Address - Fax:754-300-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty