=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194160606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN MEDICAL CLINIC CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2013
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD STE 1R6A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-362-6994
-----------------------------------------------------
Fax | 786-360-1698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD STE 1R6A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-362-6994
-----------------------------------------------------
Fax | 786-360-1698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ISABEL OSORIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-362-6994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | HCC10563
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------