Provider Demographics
NPI:1902655814
Name:ADVANCE MDCARE COMMUNITY CLINIC INC
Entity type:Organization
Organization Name:ADVANCE MDCARE COMMUNITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-363-2762
Mailing Address - Street 1:290 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5260
Mailing Address - Country:US
Mailing Address - Phone:305-363-2762
Mailing Address - Fax:305-885-8985
Practice Address - Street 1:290 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5260
Practice Address - Country:US
Practice Address - Phone:305-363-2762
Practice Address - Fax:305-885-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care