Provider Demographics
NPI:1952795064
Name:HOLY CROSS MEDICAL GROUP
Entity Type:Organization
Organization Name:HOLY CROSS MEDICAL GROUP
Other - Org Name:HCMG-POMPANO BEACH
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-942-8177
Mailing Address - Street 1:2700 NE 14TH STREET CAUSEWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062
Mailing Address - Country:US
Mailing Address - Phone:954-942-8177
Mailing Address - Fax:954-942-1819
Practice Address - Street 1:2700 NE 14TH STREET CSWY
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3561
Practice Address - Country:US
Practice Address - Phone:954-942-8177
Practice Address - Fax:954-942-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME8807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty