Healthcare Provider Details

I. General information

NPI: 1225320054
Provider Name (Legal Business Name): MEDGROUP MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SW 8TH ST SUITE 150
CORAL GABLES FL
33134-2300
US

IV. Provider business mailing address

5200 SW 8TH ST SUITE 150
CORAL GABLES FL
33134-2300
US

V. Phone/Fax

Practice location:
  • Phone: 305-250-5600
  • Fax: 305-250-5688
Mailing address:
  • Phone: 305-761-6685
  • Fax: 305-250-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAHCA HCC 9140
License Number StateFL

VIII. Authorized Official

Name: SANTIAGO VERA
Title or Position: MGRM
Credential:
Phone: 305-250-5600