Provider Demographics
NPI:1104870856
Name:PHYSICIANS CARE PLUC INC
Entity type:Organization
Organization Name:PHYSICIANS CARE PLUC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-510-8200
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:E214
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-510-8200
Mailing Address - Fax:954-510-0474
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:214
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-510-8200
Practice Address - Fax:954-510-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK6978OtherRAILROAD MEDICARE GROUP #
FL=========OtherEIN # FOR COMM INS ID
FLK3945Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #