Provider Demographics
NPI:1598570798
Name:MAMMOCARE, LLC
Entity type:Organization
Organization Name:MAMMOCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAFIK
Authorized Official - Middle Name:N
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-535-0465
Mailing Address - Street 1:14191 NW 166TH TER UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-8173
Mailing Address - Country:US
Mailing Address - Phone:319-535-0465
Mailing Address - Fax:
Practice Address - Street 1:6821 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4216
Practice Address - Country:US
Practice Address - Phone:352-999-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography