Healthcare Provider Details

I. General information

NPI: 1700973971
Provider Name (Legal Business Name): PEDIATRIC CARE OF POMPANO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE 19TH STREET
POMPANO BEACH FL
33060
US

IV. Provider business mailing address

6400 ATLANTIC BLVD
JACKSONVILLE FL
32211-8768
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-7638
  • Fax:
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SCOTT
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 904-805-1300