MEDICARE: VISIONS HEALTHCARE - EL PORTAL INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093735300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONS HEALTHCARE - EL PORTAL INC

Provider Business Mailing Address
First Line	:	8642 NE 2ND AVE
Second Line	:
City	:	EL PORTAL
State	:	FL
Zip	:	33138-3004
Country	:	US
Telephone Number	:	305-751-7301
Fax Number	:

Provider Business Practice Location Address
First Line	:	8642 NE 2ND AVE
Second Line	:
City	:	EL PORTAL
State	:	FL
Zip	:	33138-3004
Country	:	US
Telephone Number	:	305-751-7301
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALCOM R ROY
Credential	:
Telephone Number	:	305-751-7301

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/22/2020

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