MEDICARE: MG MEDICAL FACILITY 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1447348156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG MEDICAL FACILITY INC

Provider Business Mailing Address
First Line	:	6700 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3903
Country	:	US
Telephone Number	:	954-983-8606
Fax Number	:	954-983-8601

Provider Business Practice Location Address
First Line	:	6700 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3903
Country	:	US
Telephone Number	:	954-983-8606
Fax Number	:	954-983-8601

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARIO J GOVEA
Credential	:
Telephone Number	:	954-983-8606

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2020

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Directions to “MG MEDICAL FACILITY INC ” Practice Location

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