Provider Demographics
NPI:1396166252
Name:M CARE MEDICAL CENTER INC.
Entity type:Organization
Organization Name:M CARE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMILCARE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-252-4872
Mailing Address - Street 1:3501 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-3523
Mailing Address - Country:US
Mailing Address - Phone:772-252-4872
Mailing Address - Fax:772-252-4873
Practice Address - Street 1:3501 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3523
Practice Address - Country:US
Practice Address - Phone:772-252-4872
Practice Address - Fax:772-252-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 261QP2300X, 207Q00000X
FLP13000065004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016139500Medicaid