Organization
MEDI MD
Active
Other names
St Johns Wellness Group
Organization subpart
No
Provider details
NPI number
Authorized official
SEBASTIAN AHMED (EXEC)
(888) 674-0160
Entity
Organization
Contact information
Practice address
7950 SW 30TH ST STE 200, DAVIE, FL 33328-1979
(888) 674-0160
(888) 467-1802
Mailing address
7950 SW 30TH ST STE 200, DAVIE, FL 33328-1979
(888) 674-0160
(866) 467-1802
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
602238
FL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
0601
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001991000
—
FL
01
—
98322
BCBS
FL
01
—
DQ5523
RR MEDICARE
FL
Enumeration date
08/31/2008
Last updated
07/21/2022
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