1295110203 NPI number — METCARE OF ORANGE CITY

Table of content: MICHAEL ANGUS BADGER M.D. (NPI 1053399048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295110203 NPI number — METCARE OF ORANGE CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METCARE OF ORANGE CITY
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:
1295110203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2024
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 STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-500-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2669 ENTERPRISE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-774-0491
Provider Business Practice Location Address Fax Number:
386-774-7160
Provider Enumeration Date:
07/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BONETTI
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
305-500-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CX415B . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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