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General NPI Number Information
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NPI Number | 1770894453
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 750 S FEDERAL HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-5424
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Country | US
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Telephone | 954-342-8800
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Fax | 954-342-8100
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Provider Business Mailing Address
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Address Line | 750 S FEDERAL HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-5424
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Country | US
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Telephone | 954-342-8800
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Fax | 954-342-8100
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Authorized Official
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Title or Position | MBR
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Name | DR. SANDRO BACCHELLI
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Credential | M.D.
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Telephone | 954-342-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | L02000023475
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License Number State | FL
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