Healthcare Provider Details

I. General information

NPI: 1831640861
Provider Name (Legal Business Name): ADVANCE MDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

IV. Provider business mailing address

294 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

V. Phone/Fax

Practice location:
  • Phone: 877-632-2732
  • Fax: 305-885-8984
Mailing address:
  • Phone: 877-632-2732
  • Fax: 305-885-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME79915
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME79915
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberME79915
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN C RONDON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 18776322732