Provider Demographics
NPI:1962651125
Name:MANAGED CARE GROUP
Entity type:Organization
Organization Name:MANAGED CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-439-3783
Mailing Address - Street 1:3109 GRAND AVE
Mailing Address - Street 2:277
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5103
Mailing Address - Country:US
Mailing Address - Phone:800-316-3183
Mailing Address - Fax:866-810-9894
Practice Address - Street 1:3109 GRAND AVE
Practice Address - Street 2:277
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5103
Practice Address - Country:US
Practice Address - Phone:800-316-3183
Practice Address - Fax:866-810-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0324990 00Medicaid