Healthcare Provider Details

I. General information

NPI: 1134140114
Provider Name (Legal Business Name): HUMANA MEDICAL PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 W SUNRISE BLVD
PLANTATION FL
33313-4407
US

IV. Provider business mailing address

6971 W SUNRISE BLVD
PLANTATION FL
33313-4407
US

V. Phone/Fax

Practice location:
  • Phone: 954-321-7888
  • Fax: 954-321-7884
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPH10250
License Number StateFL

VIII. Authorized Official

Name: RAY FLOYD
Title or Position: MANAGER
Credential:
Phone: 954-321-7888