MEDICARE: MEDICAL & PSYCHIATRIC HEALTH RESEARCH GROUP OF FLORIDA

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	302R00000X	Health Maintenance Organization	PA9100829	FL

General Provider Information

NPI Number	:	1487015533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL & PSYCHIATRIC HEALTH RESEARCH GROUP OF FLORIDA

Provider Business Mailing Address
First Line	:	15135 NW 89TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-1364
Country	:	US
Telephone Number	:	305-747-8866
Fax Number	:	305-508-6622

Provider Business Practice Location Address
First Line	:	15135 NW 89TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-1364
Country	:	US
Telephone Number	:	305-747-8866
Fax Number	:	305-508-6622

Authorized Official
Title or Position	:	CEO
Name	:	HENRY P NORIEGA
Credential	:	EHA MBA
Telephone Number	:	305-747-8866

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	03/17/2016

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