1114945086 NPI number — CONTINUCARE MEDICAL MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114945086 NPI number — CONTINUCARE MEDICAL MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTINUCARE MEDICAL MANAGEMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONTINUCARE MEDICAL CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114945086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 BLUE LAGOON DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-500-2114
Provider Business Mailing Address Fax Number:
305-370-6024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33322-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-748-8200
Provider Business Practice Location Address Fax Number:
954-742-7755
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEMMA
Authorized Official First Name:
GEMMA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
305-500-2000

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  HCC 5460 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001887105 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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