Provider Demographics
NPI:1760763056
Name:FULL CIRCLE HEALTH CARE INC
Entity Type:Organization
Organization Name:FULL CIRCLE HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-693-0000
Mailing Address - Street 1:1190 NW 95TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2064
Mailing Address - Country:US
Mailing Address - Phone:305-693-0000
Mailing Address - Fax:888-717-7671
Practice Address - Street 1:1190 NW 95TH ST STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-693-0000
Practice Address - Fax:888-717-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952313173OtherNPI
FL14C1YOtherBLUECROSS & BLUESHIELD
FL255064400Medicaid
FL174807OtherSTAYWELL/WELLCARE
FL43740OtherBLUECROSS & BLUESHIELD
FL003574500Medicaid
FL174807OtherSTAYWELL/WELLCARE
FL174807OtherSTAYWELL/WELLCARE