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NPI Code Detail

MEDICARE: CONVIVA MEDICAL CENTER MANAGEMENT LLC

MEDICARE: CONVIVA MEDICAL CENTER MANAGEMENT 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
1207Q00000XFamily Medicine Physician
2208D00000XGeneral Practice Physician
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1871167189
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONVIVA MEDICAL CENTER MANAGEMENT LLC
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5799 LAKE WORTH RD
Second Line :
City : GREENACRES
State : FL
Zip : 33463-3207
Country : US
Telephone Number : 561-967-0234
Fax Number : 561-439-4833
Authorized Official
Title or Position : PRESIDENT
Name : KEVIN MERIWETHER
Credential :
Telephone Number : 305-500-2000
Provider Enumeration Date : 05/20/2021
Last Update Date : 06/10/2024

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Directions to “CONVIVA MEDICAL CENTER MANAGEMENT LLC ” Practice Location

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