Provider Demographics
NPI:1881133908
Name:METCARE OF FLORIDA INC,
Entity type:Organization
Organization Name:METCARE OF FLORIDA INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2109
Mailing Address - Street 1:6101 BLUE LAGOON DR
Mailing Address - Street 2:STE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2055
Mailing Address - Country:US
Mailing Address - Phone:786-552-3143
Mailing Address - Fax:305-370-6024
Practice Address - Street 1:711 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1823
Practice Address - Country:US
Practice Address - Phone:386-760-8116
Practice Address - Fax:386-760-0532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METCARE OF FLORIDA INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-22
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty