MEDICARE: CAN COMMUNITY HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21725	OTHER		FL BCBS GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174190524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAN COMMUNITY HEALTH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1000 DEPT 394
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	941-300-4440
Fax Number	:	941-404-1760

Provider Business Practice Location Address
First Line	:	315 SE 14TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1929
Country	:	US
Telephone Number	:	754-701-6920
Fax Number	:	855-643-6201

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	RISHI B PATEL
Credential	:
Telephone Number	:	941-300-4440

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	01/30/2024

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