Healthcare Provider Details

I. General information

NPI: 1851053920
Provider Name (Legal Business Name): AMICUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 N STATE ROAD 7
PLANTATION FL
33317-2834
US

IV. Provider business mailing address

480 N STATE ROAD 7
PLANTATION FL
33317-2834
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-9580
  • Fax: 954-797-0473
Mailing address:
  • Phone: 954-791-9580
  • Fax: 954-797-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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