Healthcare Provider Details

I. General information

NPI: 1639561418
Provider Name (Legal Business Name): METCARE OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NE 19TH DR
OKEECHOBEE FL
34972-1932
US

IV. Provider business mailing address

6101 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-6431
  • Fax: 863-763-2319
Mailing address:
  • Phone: 305-500-2114
  • Fax: 305-370-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEMMA ROSELLO
Title or Position: VP OPERATIONS
Credential:
Phone: 305-500-2000