| Wellcare Medical Clinic Llc | |
|
2901 Coral Hills Drive Suite 250 Coral Springs FL 33065-4146 | |
| (954) 603-5508 | |
| Not Available |
| Full Name | Wellcare Medical Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2901 Coral Hills Drive, Coral Springs, Florida |
| Authorized Official Name and Position | Simon C Wong (PRESIDENT) |
| Authorized Official Contact | 9543834262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellcare Medical Clinic Llc 2901 Coral Hills Drive Suite 250 Coral Springs FL 33065-4146 Ph: (954) 603-5508 | Wellcare Medical Clinic Llc 2901 Coral Hills Drive Suite 250 Coral Springs FL 33065-4146 Ph: (954) 603-5508 |
| NPI Number | 1730485616 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 02/10/2011 |
| Medicare PECOS PAC ID | 0749468858 |
|---|---|
| Medicare Enrollment ID | O20110620000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730485616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS10509 (Florida) | Primary |
| Provider Name | Simon C Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548411457 PECOS PAC ID: 5991821142 Enrollment ID: I20100925000200 |
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