1770501488 NPI number — CONTINUCARE MEDICAL MANAGEMENT, INC.

Table of content: (NPI 1770501488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770501488 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:
1770501488
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:
228 W ALEXANDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563-7157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-754-5480
Provider Business Practice Location Address Fax Number:
813-754-2251
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSELLO
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 5453 , 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: 001887108 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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