Provider Demographics
NPI:1700202264
Name:ADVANCED CARE MSO INC
Entity Type:Organization
Organization Name:ADVANCED CARE MSO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-543-4327
Mailing Address - Street 1:6355 NW 36TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7027
Mailing Address - Country:US
Mailing Address - Phone:786-543-4327
Mailing Address - Fax:305-874-3905
Practice Address - Street 1:6355 NW 36TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7027
Practice Address - Country:US
Practice Address - Phone:786-543-4327
Practice Address - Fax:305-874-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management