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General NPI Number Information
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NPI Number | 1497062012
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Entity Type | Organization
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Legal Business Name | ICON MEDICAL CENTERS, LLC
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 232 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33130-3514
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Country | US
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Telephone | 305-858-8845
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Fax | 305-858-8840
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Provider Business Mailing Address
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Address Line | PO BOX 12220
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City | MIAMI
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State | FL
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Zip | 33101-2220
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Country | US
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Telephone | 305-858-8845
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Fax | 305-858-8840
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT M AMODIO
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Credential |
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Telephone | 305-858-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME75244
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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