=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316778665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCENDMED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2024
-----------------------------------------------------
Last Update Date | 08/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5458 TOWN CENTER RD STE 2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-954-4998
-----------------------------------------------------
Fax | 561-431-6175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5458 TOWN CENTER RD STE 2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-954-4998
-----------------------------------------------------
Fax | 561-431-6175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CHRISTINE RICE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-972-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------