1700824992 NPI number — MEDCARE ENTERPRISES 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 1700824992 NPI number — MEDCARE ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCARE ENTERPRISES 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:
Provider Other Organization Name Type Code:
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:
1700824992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 SW 8TH ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33135-3435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-300-9241
Provider Business Mailing Address Fax Number:
305-541-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12404 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33181-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-300-9241
Provider Business Practice Location Address Fax Number:
305-541-6565
Provider Enumeration Date:
06/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-300-9241

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  686610 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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