Provider Demographics
NPI:1760660021
Name:PROFESSIONAL HEALTHCARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE ASSOCIATES LLC
Other - Org Name:INTENSIVE CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-322-4116
Mailing Address - Street 1:8950 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2133
Mailing Address - Country:US
Mailing Address - Phone:305-322-4116
Mailing Address - Fax:305-666-2252
Practice Address - Street 1:8950 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2133
Practice Address - Country:US
Practice Address - Phone:305-322-4116
Practice Address - Fax:305-666-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45897207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372492100Medicaid
FL96846Medicare UPIN