| Atlantic Medical Group | |
|
1541 S Wickham Rd West Melbourne FL 32904-3540 | |
| (321) 726-6331 | |
| (321) 726-6371 |
| Full Name | Atlantic Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1541 S Wickham Rd, West Melbourne, Florida |
| Authorized Official Name and Position | George Roque (PRESIDENT) |
| Authorized Official Contact | 3217266331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlantic Medical Group 1541 S Wickham Rd West Melbourne FL 32904-3540 Ph: (321) 726-6331 | Atlantic Medical Group 1541 S Wickham Rd West Melbourne FL 32904-3540 Ph: (321) 726-6331 |
| NPI Number | 1144281247 |
|---|---|
| Provider Enumeration Date | 03/29/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9931142486 |
|---|---|
| Medicare Enrollment ID | O20050606000616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144281247 | NPI | - | NPPES |
| 159351XX | Other | PREFERRED CARE PROVIDER # | |
| 37972 | Other | BCBS PROVIDER ID | |
| 1809978 | Other | FIRST HEALTH PROVIDER NO. | |
| 9303692 | Other | CIGNA PROVIDER NO. | |
| DD4702 | Other | RAILROAD MCARE GROUP # | |
| P00022983 | Other | RAILROAD MCARE PROVIDER # | |
| 246370 | Other | WELLCARE MCAID PROVIDER # | |
| 5585831 | Other | CCN NETWORK PROVIDER NO. | |
| 7274610 | Other | AETNA PROVIDER NO. | |
| 10024 | Other | FLORIDIANCARE PROVIDER # | |
| 9362860 | Other | PHCS PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME88828 (Florida) | Primary |
| Provider Name | George E Roque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376505834 PECOS PAC ID: 6709858681 Enrollment ID: I20040811000290 |
| Provider Name | Elizabeth M Ambrose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043509300 PECOS PAC ID: 9931385614 Enrollment ID: I20110513000210 |
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