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General NPI Number Information
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NPI Number | 1790905305
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL CENTER, PA.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 12251 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1956
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Country | US
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Telephone | 954-435-7000
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Fax | 954-435-7185
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Provider Business Mailing Address
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Address Line | 12251 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1956
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Country | US
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Telephone | 954-435-7000
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Fax | 954-435-7185
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE MORRISON
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Credential | M.D.
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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 | ME5015
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License Number State | FL
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