MEDICARE: PHYSICIANS CARE GROUP HEALTH CHOICE 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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1720253461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS CARE GROUP HEALTH CHOICE INC.

Provider Business Mailing Address
First Line	:	3520 W 18TH AVE
Second Line	:	SUITE #115
City	:	HIALEAH
State	:	FL
Zip	:	33012-4634
Country	:	US
Telephone Number	:	305-362-7633
Fax Number	:	305-823-0096

Provider Business Practice Location Address
First Line	:	3520 W. 18 AVE.
Second Line	:	SUITE #115
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-362-7633
Fax Number	:	305-823-0096

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ENRIQUE ZAMORA
Credential	:
Telephone Number	:	305-362-7633

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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