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Conviva Medical Center Management LLC

Organization Active NPI Internal Medicine Physician · Lauderdale Lakes, FL

NPI 1760056071 · NPPES record last updated May 22, 2024

Key facts

NPI
1760056071
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
CONVIVA MEDICAL CENTER MANAGEMENT LLC
Practice address
4850 W Oakland Park Blvd Ste 148
Lauderdale Lakes, FL 33313-7277
Phone
(954) 735-1200
Fax
(954) 731-8408
NPI assigned
May 20, 2021
Organization subpart
Yes
Parent organization (as reported)
CONVIVA MEDICAL CENTER MANAGEMENT LLC

Authorized official

Name
Kevin Meriwether
Title
President
Phone
(305) 500-2000

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0712868Conviva Medical Center Management, LLC
4850 W Oakland Park Blvd Ste 148, Lauderdale Lakes, FL 33313		Certificate of waiverAug 31, 2026

National Provider Directory

Tax ID family
Conviva Med Ctr MGMT LLC (76 organizations share this tax ID)
Part of
Conviva Med Ctr MGMT LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X

Addresses

Primary practice location

4850 W Oakland Park Blvd Ste 148
Lauderdale Lakes, FL 33313-7277

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names

  • Conviva West Oakland Other name

Other providers in Lauderdale Lakes, FL

All providers in Lauderdale Lakes, FL · Internal Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.