Basic Information
| Provider Information | |||||||||
| NPI: | 1134338593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA MEDICAL CENTERS, INC | ||||||||
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| OtherOrganizationName: | SFMC GROUP OF WEST PALM BEACH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 45TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618444353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2100 45TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618444353 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | ADETULA | ||||||||
| AuthorizedOfficialFirstName: | JIMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 9544722999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.