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PREMIUM CARE DOCTORS CORP. NPI 1174695449


NPI Information

NPI: 1174695449
Provider Name: PREMIUM CARE DOCTORS CORP.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 10D1085088

Address:
1816 E 4TH AVE
HIALEAH, FL
ZIP 33010
Phone: (305) 805-0012
Get Directions

PREMIUM CARE DOCTORS CORP. is a family medicine in Hialeah, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PREMIUM CARE DOCTORS CORP. NPI is 1174695449. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1816 E 4TH AVE
HIALEAH, FL
ZIP 33010-115
Phone: (305) 805-0012
Fax: (305) 883-9003

The provider's authorized official is Manuel Alfredo Galguera .
The authorized official title is President and has the following contact phone number (305) 805-0012.

The CLIA number assigned to this NPI record is 10D1085088 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/14/2006 and was last updated on 8/3/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsNo
22080A0000XPediatricsAdolescent MedicineNo
3207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1258699100MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.