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	261Q00000X	Clinic/Center	HCC6432	FL

General Provider Information

NPI Number	:	1710227988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG MEDICAL FACILITY INC

Provider Business Mailing Address
First Line	:	1821 NW 123RD AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-3825
Country	:	US
Telephone Number	:	954-432-8856
Fax Number	:	954-432-8955

Provider Business Practice Location Address
First Line	:	1821 NW 123RD AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-3825
Country	:	US
Telephone Number	:	954-432-8856
Fax Number	:	954-432-8955

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MARIA DE JESUS RODRIGUEZ
Credential	:
Telephone Number	:	954-432-8856

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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Directions to “MG MEDICAL FACILITY INC ” Practice Location

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