Provider Demographics
NPI:1992175400
Name:MENTHOR MEDICAL HOLDINGS LLC
Entity type:Organization
Organization Name:MENTHOR MEDICAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-400-0930
Mailing Address - Street 1:1321 NW 14TH STREET
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-547-1444
Mailing Address - Fax:305-547-6787
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-547-1444
Practice Address - Fax:305-547-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIO345AMedicare UPIN