Healthcare Provider Details

I. General information

NPI: 1265772768
Provider Name (Legal Business Name): TOTAL MANAGED CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 SW 30TH CT
MIAMI FL
33133-3616
US

IV. Provider business mailing address

2990 SW 30TH CT
MIAMI FL
33133-3616
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-2532
  • Fax: 786-513-0748
Mailing address:
  • Phone: 305-305-2532
  • Fax: 786-513-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY T KING
Title or Position: PRESIDENT
Credential: RN
Phone: 305-305-2532