Provider Demographics
NPI:1720253461
Name:PHYSICIANS CARE GROUP HEALTH CHOICE INC.
Entity Type:Organization
Organization Name:PHYSICIANS CARE GROUP HEALTH CHOICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-7633
Mailing Address - Street 1:3520 W 18TH AVE
Mailing Address - Street 2:SUITE #115
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4634
Mailing Address - Country:US
Mailing Address - Phone:305-362-7633
Mailing Address - Fax:305-823-0096
Practice Address - Street 1:3520 W. 18 AVE.
Practice Address - Street 2:SUITE #115
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-362-7633
Practice Address - Fax:305-823-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization