MEDICARE: 121 MEDICAL CENTER LLC

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

General Provider Information

NPI Number	:	1982384814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	121 MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	11903 SOUTHERN BLVD STE 108
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-793-1475
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 W COMMERCIAL BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3407
Country	:	US
Telephone Number	:	954-530-9770
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROSNY SIMEON
Credential	:
Telephone Number	:	561-793-1475

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	06/27/2025

Similar Medicare Providers

1760485437 — DR. MARY MAILLOUX MD
Practice Location Address:

3333 W COMMERCIAL BLVD , STE 210
FT LAUDERDALE, FL
33309-3407

Practice Phone: 877-751-1157
Practice Fax: 919-425-1596

1659754919 — FREDERICK NELSON LABORDE M.D.
Practice Location Address:

3333 W COMMERCIAL BLVD STE 110
FORT LAUDERDALE, FL
33309-3407

Practice Phone: 954-530-9770
Practice Fax:

1144844358 — OLIVIA BARANSKI MD
Practice Location Address:

3333 W COMMERCIAL BLVD STE 110
FORT LAUDERDALE, FL
33309-3407

Practice Phone: 760-201-6711
Practice Fax:

1780253831 — MR. JAMES YVAN BENSON RINCHERE PHYSICIAN ASSISTANT
Practice Location Address:

3333 W COMMERCIAL BLVD STE 110
FORT LAUDERDALE, FL
33309-3407

Practice Phone: 754-315-0660
Practice Fax:

1124616420 — JESSICA FERNANDEZ PA
Practice Location Address:

624 SE 6TH ST
FORT LAUDERDALE, FL
33301-3407

Practice Phone: 954-826-0926
Practice Fax:

1538164728 — DR. HEIDI MARIE MCCULLAH O.D.
Practice Location Address:

4845 24TH AVE
FORT GRATIOT, MI
48059-3407

Practice Phone: 810-358-4114
Practice Fax: 810-385-5212

Directions to “121 MEDICAL CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.