Basic Information
| Provider Information | |||||||||
| NPI: | 1336712678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMICUS MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 CONCORD TER | ||||||||
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| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545055000 | ||||||||
| FaxNumber: | 9548389660 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 JFK DR | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615401657 | ||||||||
| FaxNumber: | 5615401659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | ECHEVARRIA | ||||||||
| AuthorizedOfficialFirstName: | HERIKA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTILAING | ||||||||
| AuthorizedOfficialTelephone: | 9545055000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.