Provider Demographics
NPI:1770501488
Name:CONTINUCARE MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:CONTINUCARE MEDICAL MANAGEMENT, INC.
Other - Org Name:CONTINUCARE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
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 1:228 W ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7157
Practice Address - Country:US
Practice Address - Phone:813-754-5480
Practice Address - Fax:813-754-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 5453261QM1300X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001887108Medicaid
FL001887108Medicaid