MEDICARE: AV MEDICAL CENTER INC.

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	207R00000X	Internal Medicine Physician
2	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1245075936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AV MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	3357 SW FRANKFORD ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4938
Country	:	US
Telephone Number	:	786-547-2767
Fax Number	:	305-402-0941

Provider Business Practice Location Address
First Line	:	1301 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4825
Country	:	US
Telephone Number	:	772-577-6232
Fax Number	:	305-402-0941

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WALSIN ROMERO
Credential	:
Telephone Number	:	786-547-2767

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	12/17/2024

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