MEDICARE: SPECIALIZED ELDER CARE SERVICES FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1033812250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED ELDER CARE SERVICES FLORIDA LLC

Provider Business Mailing Address
First Line	:	2420 NE 194TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-2159
Country	:	US
Telephone Number	:	510-406-4182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 NE 194TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-2159
Country	:	US
Telephone Number	:	510-406-4182
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	DR. RIK SMITH
Credential	:	MD
Telephone Number	:	510-406-4182

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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