Organization
ATLANTIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE ROQUE M.D. (PRESIDENT)
(321) 726-6331
Entity
Organization
Contact information
Practice address
1541 S WICKHAM RD, WEST MELBOURNE, FL 32904-3540
(321) 726-6331
(321) 726-6371
Mailing address
1541 S WICKHAM RD, WEST MELBOURNE, FL 32904-3540
(321) 726-6331
(321) 726-6371
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME88828
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10024
FLORIDIANCARE PROVIDER #
—
01
—
159351XX
PREFERRED CARE PROVIDER #
—
01
—
1809978
FIRST HEALTH PROVIDER NO.
—
01
—
246370
WELLCARE MCAID PROVIDER #
—
01
—
37972
BCBS PROVIDER ID
—
01
—
5585831
CCN NETWORK PROVIDER NO.
—
01
—
7274610
AETNA PROVIDER NO.
—
01
—
9303692
CIGNA PROVIDER NO.
—
01
—
9362860
PHCS PROVIDER #
—
01
—
DD4702
RAILROAD MCARE GROUP #
—
01
—
P00022983
RAILROAD MCARE PROVIDER #
—
Enumeration date
03/29/2006
Last updated
08/22/2020
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