Healthcare Provider Details

I. General information

NPI: 1487665642
Provider Name (Legal Business Name): HEALTHCARE AMERICA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CORTEZ RD W
BRADENTON FL
34210-3104
US

IV. Provider business mailing address

3501 CORTEZ RD W
BRADENTON FL
34210-3104
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-2700
  • Fax: 941-752-2730
Mailing address:
  • Phone: 941-752-2700
  • Fax: 941-752-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WERTHER R. MARCIALES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 941-752-2700