Healthcare Provider Details

I. General information

NPI: 1629019062
Provider Name (Legal Business Name): INTENSIVE CARE CONSORTIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD
AVENTURA FL
33180
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-0821
  • Fax: 561-997-0849
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS MOAS
Title or Position: PRESIDENT
Credential:
Phone: 786-494-5154