MEDICARE: POLO 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	207Q00000X	Family Medicine Physician	ME55498	FL
2	111N00000X	Chiropractor	CH0005420	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70891	OTHER	FL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1003814187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLO MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	5030 CHAMPION BLVD
Second Line	:	SUITE G-9
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-998-0510
Fax Number	:	561-998-0163

Provider Business Practice Location Address
First Line	:	5030 CHAMPION BLVD
Second Line	:	SUITE G-9
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-998-0510
Fax Number	:	561-998-0163

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARBARA ANN TURKELL
Credential	:	D.C.
Telephone Number	:	561-998-0510

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	09/04/2007

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Directions to “POLO MEDICAL CENTER INC ” Practice Location

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