MEDICARE: EM MSO GROUP CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	305R00000X	Preferred Provider Organization
3	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1306598669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EM MSO GROUP CORP.

Provider Business Mailing Address
First Line	:	5835 BLUE LAGOON DR STE 300
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-6046
Country	:	US
Telephone Number	:	305-298-3272
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 BLUE LAGOON DR STE 300
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-6046
Country	:	US
Telephone Number	:	305-298-3272
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. JAVIER MENENDEZ
Credential	:
Telephone Number	:	305-298-3272

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/19/2022

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Directions to “EM MSO GROUP CORP. ” Practice Location

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