Healthcare Provider Details

I. General information

NPI: 1063169084
Provider Name (Legal Business Name): AMEN CLINICS INC, FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S PARK RD STE 140
HOLLYWOOD FL
33021-8351
US

IV. Provider business mailing address

200 S PARK RD STE 140
HOLLYWOOD FL
33021-8351
US

V. Phone/Fax

Practice location:
  • Phone: 754-260-6000
  • Fax: 754-220-1776
Mailing address:
  • Phone: 754-260-6000
  • Fax: 754-220-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA T MCCORMICK
Title or Position: DATA SYSTEM SPECIALIST
Credential: MS
Phone: 703-880-4000