Provider Demographics
NPI:1821238882
Name:WE CARE MEDICAL CORP
Entity Type:Organization
Organization Name:WE CARE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-409-1287
Mailing Address - Street 1:PO BOX 471602
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33247-1602
Mailing Address - Country:US
Mailing Address - Phone:305-559-7996
Mailing Address - Fax:
Practice Address - Street 1:714 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4332
Practice Address - Country:US
Practice Address - Phone:305-409-1287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME058305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269915000Medicaid