Provider Demographics
NPI:1013469774
Name:LOVING CARE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:LOVING CARE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:SUZY
Authorized Official - Last Name:ST CYR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-201-7852
Mailing Address - Street 1:17801 NW 2ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5029
Mailing Address - Country:US
Mailing Address - Phone:786-201-7852
Mailing Address - Fax:
Practice Address - Street 1:17801 NW 2ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-5029
Practice Address - Country:US
Practice Address - Phone:786-201-7852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty