Provider Demographics
NPI:1932999513
Name:MEDGROUP MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MEDGROUP MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-761-6685
Mailing Address - Street 1:304 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6039
Mailing Address - Country:US
Mailing Address - Phone:305-761-6685
Mailing Address - Fax:
Practice Address - Street 1:304 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6039
Practice Address - Country:US
Practice Address - Phone:305-761-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDGROUP MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty