Healthcare Provider Details

I. General information

NPI: 1013562446
Provider Name (Legal Business Name): FLORIDA MEDICAL CENTER GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NW 15TH ST
HOMESTEAD FL
33030-4266
US

IV. Provider business mailing address

1501 NW 36TH ST
MIAMI FL
33142-5559
US

V. Phone/Fax

Practice location:
  • Phone: 786-886-1030
  • Fax:
Mailing address:
  • Phone: 786-378-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADELAINE SOUTO
Title or Position: CEO
Credential: AO
Phone: 786-378-8200