Provider Demographics
NPI:1760873905
Name:METCARE OF WEST PALM BEACH
Entity Type:Organization
Organization Name:METCARE OF WEST PALM BEACH
Other - Org Name:CONVIVA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:MS
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 1:1411 N FLAGLER DR STE 6800
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-842-7293
Practice Address - Fax:561-842-5554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN HEALTH NETWORKS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-10
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX415AOtherMEDICARE PTAN