Healthcare Provider Details

I. General information

NPI: 1770967077
Provider Name (Legal Business Name): METCARE OF PALM COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOSPITAL DR STE 125
PALM COAST FL
32164-2455
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-7005
  • Fax:
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: KEVIN MERIWETHER
Title or Position: DIVISION PRESIDENT
Credential:
Phone: 305-500-2000