MEDICARE: PATH MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1003234659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-735-6584
Fax Number	:	954-735-6589

Provider Business Practice Location Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-735-6584
Fax Number	:	954-735-6589

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DENISE L FOGAROS ATLER
Credential	:
Telephone Number	:	954-735-6584

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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