Basic Information
| Provider Information | |||||||||
| NPI: | 1144671074 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIMED CARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W HILLSBORO BLVD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544283500 | ||||||||
| FaxNumber: | 9544281650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 W HILLSBORO BLVD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544283500 | ||||||||
| FaxNumber: | 9544281650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2016 | ||||||||
| LastUpdateDate: | 06/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | VEGA | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9544283500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAPS MEDICAL MANAGEMENT, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.