Provider Demographics
NPI:1831640861
Name:ADVANCE MDCARE INC
Entity Type:Organization
Organization Name:ADVANCE MDCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-363-2762
Mailing Address - Street 1:294 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5260
Mailing Address - Country:US
Mailing Address - Phone:877-632-2732
Mailing Address - Fax:305-885-8984
Practice Address - Street 1:294 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5260
Practice Address - Country:US
Practice Address - Phone:877-632-2732
Practice Address - Fax:305-885-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLME79915261QU0200X, 302R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104171200Medicaid
FL6TH5COtherFLORIDA BLUE