Healthcare Provider Details

I. General information

NPI: 1619584521
Provider Name (Legal Business Name): MEDGROUP MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W 68TH ST STE 100
HIALEAH FL
33016-1802
US

IV. Provider business mailing address

2150 W 68TH ST STE 102
HIALEAH FL
33016-1802
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4443
  • Fax:
Mailing address:
  • Phone: 305-854-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANTIAGO VERA
Title or Position: MGRM
Credential: MBA
Phone: 305-761-6685