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General NPI Number Information
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NPI Number | 1710034376
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Entity Type | Organization
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Legal Business Name | CHILDRENS MEDICAL CENTER
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 4651 SHERIDAN ST SUITE 270
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3457
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Country | US
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Telephone | 954-989-6000
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Fax | 954-378-4775
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Provider Business Mailing Address
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Address Line | 4651 SHERIDAN ST SUITE 270
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3457
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Country | US
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Telephone | 954-989-6000
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Fax | 954-378-4775
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE MORRISON
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Credential | MD
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Telephone | 954-989-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | ME14634
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License Number State | FL
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