MEDICARE: G4 MEDICAL CENTERS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	1143	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9700	OTHER	FL	BC BS OF FL
2	75804GM	OTHER	PR	TRIPLE S BC/BS OF P.R.

General Provider Information

NPI Number	:	1497756712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G4 MEDICAL CENTERS, INC

Provider Business Mailing Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	STE 201
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-229-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	STE 201
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-229-0204
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AHMAD MORADI
Credential	:	PHD
Telephone Number	:	954-229-0900

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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