| Blue Medici Corporation | |
|
12780 Sw 71st Ave Pinecrest FL 33156-6239 | |
| (787) 902-2594 | |
| (305) 470-1853 |
| Full Name | Blue Medici Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 12780 Sw 71st Ave, Pinecrest, Florida |
| Authorized Official Name and Position | Luis Hernandez Rosado (OWNER) |
| Authorized Official Contact | 7879022594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Medici Corporation 12780 Sw 71st Ave Pinecrest FL 33156-6239 Ph: (787) 902-2594 | Blue Medici Corporation 12780 Sw 71st Ave Pinecrest FL 33156-6239 Ph: (787) 902-2594 |
| NPI Number | 1942927231 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 11/01/2022 |
| Medicare PECOS PAC ID | 4587033865 |
|---|---|
| Medicare Enrollment ID | O20221208000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942927231 | NPI | - | NPPES |
| 1144527466 | Other | FL | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Luis Hernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144527466 PECOS PAC ID: 9830340645 Enrollment ID: I20181116001546 |
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