Healthcare Provider Details

I. General information

NPI: 1992375281
Provider Name (Legal Business Name): AMICUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 W BOYNTON BEACH BLVD STE D
BOYNTON BEACH FL
33436-4502
US

IV. Provider business mailing address

1300 CONCORD TER STE 210
SUNRISE FL
33323-2899
US

V. Phone/Fax

Practice location:
  • Phone: 561-738-7900
  • Fax: 561-369-3254
Mailing address:
  • Phone: 954-505-5000
  • Fax: 954-838-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HERIKA MARIE ECHEVARRIA
Title or Position: CREDENTIALING ADMINISTRATOR
Credential:
Phone: 954-505-5000