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General NPI Number Information
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NPI Number | 1356145098
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Entity Type | Organization
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Legal Business Name | MGC HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 10502 PELICAN DR
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City | WELLINGTON
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State | FL
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Zip | 33414-6164
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Country | US
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Telephone | 561-797-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 10502 PELICAN DR
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City | WELLINGTON
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State | FL
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Zip | 33414-6164
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JOHN RYAN
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Credential |
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Telephone | 407-377-5484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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