Healthcare Provider Details

I. General information

NPI: 1366104382
Provider Name (Legal Business Name): AMICUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W ATLANTIC BLVD STE 102
POMPANO BEACH FL
33060-6048
US

IV. Provider business mailing address

321 W ATLANTIC BLVD STE 102
POMPANO BEACH FL
33060-6048
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-3122
  • Fax:
Mailing address:
  • Phone: 954-781-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal 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