Healthcare Provider Details

I. General information

NPI: 1043713787
Provider Name (Legal Business Name): FCHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST STE 203
MIAMI FL
33150-2064
US

IV. Provider business mailing address

1190 NW 95TH ST STE 203
MIAMI FL
33150-2064
US

V. Phone/Fax

Practice location:
  • Phone: 786-535-4679
  • Fax:
Mailing address:
  • Phone: 786-535-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberHCC10165
License Number StateFL

VIII. Authorized Official

Name: MAURICE SPENCE
Title or Position: PRESIDENT
Credential:
Phone: 786-535-4679