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
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1922745116
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	:	973 SE FEDERAL HWY STE 973B
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3702
Country	:	US
Telephone Number	:	772-261-9130
Fax Number	:	855-618-2456

Authorized Official
Title or Position	:	DIVISION PRESIDENT
Name	:	KEVIN MERIWETHER
Credential	:
Telephone Number	:	305-500-2000

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	06/21/2024

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