MEDICARE: PREMIER FAMILY AND PALLIATIVE 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	OS10256	FL
2	208VP0000X	Pain Medicine Physician	OS10256	FL
3	207Q00000X	Family Medicine Physician	OS10256	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679889968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FAMILY AND PALLIATIVE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1 W SAMPLE RD
Second Line	:	SUITE 104
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3547
Country	:	US
Telephone Number	:	954-782-2802
Fax Number	:	954-782-2881

Provider Business Practice Location Address
First Line	:	1 W SAMPLE RD # 3104
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3547
Country	:	US
Telephone Number	:	954-782-2802
Fax Number	:

Authorized Official
Title or Position	:	MCC
Name	:	LAURA BURKE
Credential	:
Telephone Number	:	954-782-2802

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	01/06/2011

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