MEDICARE: PLAZA ADVANTAGE HEALTH CORP

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1669886057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA ADVANTAGE HEALTH CORP

Provider Business Mailing Address
First Line	:	1800 NE 168TH ST
Second Line	:	SUITE 200
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3023
Country	:	US
Telephone Number	:	305-917-0400
Fax Number	:	305-917-0410

Provider Business Practice Location Address
First Line	:	1800 NE 168TH ST
Second Line	:	SUITE 200
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3023
Country	:	US
Telephone Number	:	305-917-0400
Fax Number	:	305-917-0410

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	WILLIAM ZUBKOFF
Credential	:
Telephone Number	:	305-917-0400

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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Directions to “PLAZA ADVANTAGE HEALTH CORP ” Practice Location

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