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General NPI Number Information
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NPI Number | 1033716279
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Entity Type | Organization
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Legal Business Name | VILLAGE MEDICAL CENTER, LLC.
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 13400 SW 10TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1833
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Country | US
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Telephone | 954-900-1466
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Fax | 954-900-1553
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Provider Business Mailing Address
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Address Line | 13400 SW 10TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1833
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Country | US
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Telephone | 954-900-1466
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Fax | 954-900-1553
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Authorized Official
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Title or Position | CEO/FINANCE
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Name | JOSHUA ALLAN RUSKIN
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Credential |
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Telephone | 954-900-1466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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