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General NPI Number Information
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NPI Number | 1063158202
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY MEDICAL CARE , LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 4420 SHERIDAN ST STE A
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3552
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Country | US
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Telephone | 954-888-4223
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Fax | 954-874-0840
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Provider Business Mailing Address
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Address Line | 3156 INVERNESS
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City | WESTON
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State | FL
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Zip | 33332-1816
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Country | US
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Telephone | 954-707-1955
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KIM GOLDMINTZ
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Credential | D.O.
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Telephone | 954-707-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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