Provider Demographics
NPI:1720631450
Name:MEDCARE, LLC
Entity Type:Organization
Organization Name:MEDCARE, LLC
Other - Org Name:MEDCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNCAL
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:786-343-9289
Mailing Address - Street 1:3900 BROADWAY AVE
Mailing Address - Street 2:STE A1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8197
Mailing Address - Country:US
Mailing Address - Phone:239-789-1850
Mailing Address - Fax:239-789-1481
Practice Address - Street 1:3900 BROADWAY AVE
Practice Address - Street 2:STE A1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8197
Practice Address - Country:US
Practice Address - Phone:239-789-1850
Practice Address - Fax:239-789-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL19000122649OtherDOCUMENT NUMBER