Provider Demographics
NPI:1902496367
Name:FLORIDA MEDICAL CENTER GROUP, INC.
Entity type:Organization
Organization Name:FLORIDA MEDICAL CENTER GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-378-8200
Mailing Address - Street 1:1501 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5559
Mailing Address - Country:US
Mailing Address - Phone:786-378-8200
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5559
Practice Address - Country:US
Practice Address - Phone:786-378-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA MEDICAL CENTER GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty