Organization
MEDICOR HEALTHCHOICE INC
Active
Other names
Medicor Healthcare Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK A MARQUEZ (VICE PRESIDENT)
(800) 250-4468
Entity
Organization
Contact information
Practice address
2200 NW 102 AVENUE SUITE 2B, DORAL, FL 33172-2225
(800) 250-4468
(888) 614-4949
Mailing address
2200 NW 102 AVENUE SUITE 2B, DORAL, FL 33172-2225
(800) 250-4468
(888) 614-4949
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
HME051
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682074300
—
FL
05
—
951866500
—
FL
01
—
HME051
AHCA
FL
01
—
PH26070
PHARMACY LICENSE
FL
01
—
PH26071
PHARMACY LICENSE
FL
Enumeration date
07/22/2005
Last updated
03/10/2023
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