Provider Type Icon

ATLANTIC MEDICAL GROUP NPI 1144281247


NPI Information

NPI: 1144281247
Provider Name: ATLANTIC MEDICAL GROUP
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 10D1081969

Address:
1541 S WICKHAM RD
WEST MELBOURNE, FL
ZIP 32904
Phone: (321) 726-6331
Get Directions

ATLANTIC MEDICAL GROUP is an internal medicine in West Melbourne, FL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. ATLANTIC MEDICAL GROUP NPI is 1144281247. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1541 S WICKHAM RD
WEST MELBOURNE, FL
ZIP 32904-540
Phone: (321) 726-6331
Fax: (321) 726-6371

The provider's authorized official is George Roque .
The authorized official title is President and has the following contact phone number (321) 726-6331.

The CLIA number assigned to this NPI record is 10D1081969 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/29/2006 and was last updated on 8/22/2020.


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
1207R00000XInternal MedicineME88828FLORIDAYes

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
17274610OTHERAETNA PROVIDER NO.
2246370OTHERWELLCARE MCAID PROVIDER #
35585831OTHERCCN NETWORK PROVIDER NO.
4DD4702OTHERRAILROAD MCARE GROUP #
5P00022983OTHERRAILROAD MCARE PROVIDER #
610024OTHERFLORIDIANCARE PROVIDER #
71809978OTHERFIRST HEALTH PROVIDER NO.
89303692OTHERCIGNA PROVIDER NO.
99362860OTHERPHCS PROVIDER #
10159351XXOTHERPREFERRED CARE PROVIDER #
1137972OTHERBCBS PROVIDER ID

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.