MEDICARE: DFDFDF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	8666	FL

General Provider Information

NPI Number	:	1174836092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFDFDF

Provider Business Mailing Address
First Line	:	7156 COLONY CLUB DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7156 COLONY CLUB DR
Second Line	:	309
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7836
Country	:	US
Telephone Number	:	561-420-5120
Fax Number	:

Authorized Official
Title or Position	:	DOC
Name	:	DR. DFDFDFD DFD FDFDFDF
Credential	:	MD
Telephone Number	:	561-412-2015

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	07/20/2010

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