Healthcare Provider Details

I. General information

NPI: 1114565124
Provider Name (Legal Business Name): COMPCARE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 08/02/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W OAKLAND PARK BLVD STE 310 4/6
OAKLAND PARK FL
33311-1389
US

IV. Provider business mailing address

2701 W OAKLAND PARK BLVD STE 3701 4/6
OAKLAND PARK FL
33311-1388
US

V. Phone/Fax

Practice location:
  • Phone: 954-306-3481
  • Fax: 445-300-9263
Mailing address:
  • Phone: 954-306-3481
  • Fax: 445-300-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE BROWN
Title or Position: OWNER
Credential: APRN
Phone: 954-306-3481