Healthcare Provider Details

I. General information

NPI: 1619433869
Provider Name (Legal Business Name): METCARE OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 S RIDGEWOOD AVE
PORT ORANGE FL
32127-4501
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 386-761-0050
  • Fax: 386-761-1167
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MERIWETHER
Title or Position: DIVISION PRESIDENT
Credential:
Phone: 305-500-2000