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General NPI Number Information
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NPI Number | 1679889968
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Entity Type | Organization
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Legal Business Name | PREMIER FAMILY AND PALLIATIVE MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 1 W SAMPLE RD # 3104
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3547
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Country | US
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Telephone | 954-782-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W SAMPLE RD SUITE 104
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3547
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Country | US
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Telephone | 954-782-2802
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Fax | 954-782-2881
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Authorized Official
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Title or Position | MCC
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Name | LAURA BURKE
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Credential |
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Telephone | 954-782-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | OS10256
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | OS10256
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10256
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License Number State | FL
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