Provider Demographics
NPI:1790955425
Name:ULTIMATE HMD, LLC
Entity Type:Organization
Organization Name:ULTIMATE HMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RECAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-492-2233
Mailing Address - Street 1:6355 NW 36TH ST
Mailing Address - Street 2:SUITE # 604
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7027
Mailing Address - Country:US
Mailing Address - Phone:305-492-2233
Mailing Address - Fax:305-492-2255
Practice Address - Street 1:6355 NW 36TH ST
Practice Address - Street 2:SUITE # 604
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7027
Practice Address - Country:US
Practice Address - Phone:305-492-2233
Practice Address - Fax:305-492-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization