| 1st Care Case Management Services Llc | |
|
1400 Nw 107th Ave Ste 310 Sweetwater FL 33172-2746 | |
| (786) 542-5043 | |
| (786) 542-5049 |
| Full Name | 1st Care Case Management Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 Nw 107th Ave Ste 310, Sweetwater, Florida |
| Authorized Official Name and Position | Alexander Mata (PRESIDENT) |
| Authorized Official Contact | 7865425043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1st Care Case Management Services Llc 1400 Nw 107th Ave Ste 310 Sweetwater FL 33172-2746 Ph: (786) 542-5043 | 1st Care Case Management Services Llc 1400 Nw 107th Ave Ste 310 Sweetwater FL 33172-2746 Ph: (786) 542-5043 |
| NPI Number | 1518472414 |
|---|---|
| Provider Enumeration Date | 12/13/2017 |
| Last Update Date | 01/23/2024 |
| Certification Date | 01/23/2024 |
| Medicare PECOS PAC ID | 1355752338 |
|---|---|
| Medicare Enrollment ID | O20201123002689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518472414 | NPI | - | NPPES |
| 107235000 | Medicaid | FL | |
| 116958500 | Medicaid | FL | |
| 023273200 | Medicaid | FL |
| Provider Name | Magdiel Diaz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1518942812 PECOS PAC ID: 1951383330 Enrollment ID: I20040601001406 |
| Provider Name | Adriana Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588191308 PECOS PAC ID: 3577697259 Enrollment ID: I20180221002609 |
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