Healthcare Provider Details

I. General information

NPI: 1003814187
Provider Name (Legal Business Name): POLO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CHAMPION BLVD SUITE G-9
BOCA RATON FL
33496-2473
US

IV. Provider business mailing address

5030 CHAMPION BLVD SUITE G-9
BOCA RATON FL
33496-2473
US

V. Phone/Fax

Practice location:
  • Phone: 561-998-0510
  • Fax: 561-998-0163
Mailing address:
  • Phone: 561-998-0510
  • Fax: 561-998-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME55498
License Number StateFL

VIII. Authorized Official

Name: DR. BARBARA ANN TURKELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 561-998-0510