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General NPI Number Information
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NPI Number | 1801303847
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Entity Type | Organization
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Legal Business Name | MEDIPLUS CLINIC, INC
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 151-155 SW 6TH STREET
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City | POMPANO BEACH
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State | FL
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Zip | 33060
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Country | US
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Telephone | 561-207-7663
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Fax | 561-516-6959
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Provider Business Mailing Address
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Address Line | 151-155 SW 6TH STREET
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City | POMPANO BEACH
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State | FL
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Zip | 33060
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Country | US
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Telephone | 561-207-7663
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Fax | 561-516-6959
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JUDY NELSON
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Credential | CS
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Telephone | 561-207-7663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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