Healthcare Provider Details

I. General information

NPI: 1396166252
Provider Name (Legal Business Name): M CARE MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 ORANGE AVE
FORT PIERCE FL
34947-3523
US

IV. Provider business mailing address

3501 ORANGE AVE
FORT PIERCE FL
34947-3523
US

V. Phone/Fax

Practice location:
  • Phone: 772-252-4872
  • Fax: 772-252-4873
Mailing address:
  • Phone: 772-252-4872
  • Fax: 772-252-4873

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 Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP13000065004
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANETTE EMILCARE
Title or Position: PRESIDENT
Credential: RN
Phone: 772-252-4872