Healthcare Provider Details

I. General information

NPI: 1376970814
Provider Name (Legal Business Name): MIDWAY SPECIALTY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 E MIDWAY RD
FORT PIERCE FL
34982-7148
US

IV. Provider business mailing address

356 E MIDWAY RD
FORT PIERCE FL
34982-7148
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-9746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOTI N RAMGOPAL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 772-464-9746