Provider Demographics
NPI:1952388126
Name:G & H MEDICAL GROUP INC
Entity Type:Organization
Organization Name:G & H MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-774-1188
Mailing Address - Street 1:4800 W FLAGLER ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1401
Mailing Address - Country:US
Mailing Address - Phone:305-774-1188
Mailing Address - Fax:305-774-9070
Practice Address - Street 1:4800 W FLAGLER ST
Practice Address - Street 2:SUITE 214
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1401
Practice Address - Country:US
Practice Address - Phone:305-774-1188
Practice Address - Fax:305-774-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3983261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7557Medicare PIN