Provider Demographics
NPI:1447348156
Name:MG MEDICAL FACILITY INC
Entity type:Organization
Organization Name:MG MEDICAL FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOVEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-8606
Mailing Address - Street 1:6700 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3903
Mailing Address - Country:US
Mailing Address - Phone:954-983-8606
Mailing Address - Fax:954-983-8601
Practice Address - Street 1:6700 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3903
Practice Address - Country:US
Practice Address - Phone:954-983-8606
Practice Address - Fax:954-983-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8111Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER