MEDICARE: METCARE OF FLORIDA, 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CX415B	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1134504855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METCARE OF FLORIDA, INC.

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3641 CLYDE MORRIS BLVD
Second Line	:	SUITE 100
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-2357
Country	:	US
Telephone Number	:	305-500-2114
Fax Number	:	305-370-6024

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	JESSICA BONETTI
Credential	:
Telephone Number	:	305-500-2000

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	08/19/2024

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