Provider Demographics
NPI:1386234268
Name:MEDEC MEDICAL CARE PLLC
Entity type:Organization
Organization Name:MEDEC MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QAZIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:312-719-2211
Mailing Address - Street 1:1270 N WICKHAM RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8300
Mailing Address - Country:US
Mailing Address - Phone:321-567-2211
Mailing Address - Fax:321-286-0496
Practice Address - Street 1:1270 N WICKHAM RD STE 9
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8300
Practice Address - Country:US
Practice Address - Phone:321-567-2211
Practice Address - Fax:321-286-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8X1NOtherFL BCBS
FL110804600Medicaid