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General NPI Number Information
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NPI Number | 1063169084
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Entity Type | Organization
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Legal Business Name | AMEN CLINICS INC, FLORIDA
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 200 S PARK RD STE 140
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8351
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Country | US
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Telephone | 754-260-6000
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Fax | 754-220-1776
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Provider Business Mailing Address
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Address Line | 200 S PARK RD STE 140
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8351
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Country | US
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Telephone | 754-260-6000
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Fax | 754-220-1776
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Authorized Official
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Title or Position | DATA SYSTEM SPECIALIST
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Name | CHRISTINA T MCCORMICK
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Credential | MS
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Telephone | 703-880-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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