MEDICARE: MEDGROUP MEDICAL CENTER LLC

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	261Q00000X	Clinic/Center
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1619584521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDGROUP MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	2150 W 68TH ST STE 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1802
Country	:	US
Telephone Number	:	305-854-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 W 68TH ST STE 100
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1802
Country	:	US
Telephone Number	:	305-854-4443
Fax Number	:

Authorized Official
Title or Position	:	MGRM
Name	:	SANTIAGO VERA
Credential	:	MBA
Telephone Number	:	305-761-6685

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	10/04/2023

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Directions to “MEDGROUP MEDICAL CENTER LLC ” Practice Location

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