MEDICARE: CENTORI HEALTH, 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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1326720566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTORI HEALTH, INC

Provider Business Mailing Address
First Line	:	16 PELICAN DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1522
Country	:	US
Telephone Number	:	754-778-7920
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LAS OLAS WAY # CU1
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2363
Country	:	US
Telephone Number	:	754-778-7920
Fax Number	:

Authorized Official
Title or Position	:	VP OF ADMIN
Name	:	KATE RAGER
Credential	:
Telephone Number	:	754-778-7920

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/22/2023

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