MEDICARE: THE FENIX HEALTH GROUP, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
2	2084P0800X	Psychiatry Physician
3	208D00000X	General Practice Physician
4	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1144602681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FENIX HEALTH GROUP, INC

Provider Business Mailing Address
First Line	:	721 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	786-487-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	786-487-4535
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. JENNIFER JOHN CARBON
Credential	:
Telephone Number	:	786-487-4535

Provider Enumeration Date	:	06/21/2015
Last Update Date	:	11/20/2015

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