MEDICARE: BOF 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1063786390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOF MEDICAL CENTER ,INC

Provider Business Mailing Address
First Line	:	12440 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2521
Country	:	US
Telephone Number	:	954-239-0478
Fax Number	:	954-239-0485

Provider Business Practice Location Address
First Line	:	12440 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2521
Country	:	US
Telephone Number	:	954-239-0478
Fax Number	:	954-239-0485

Authorized Official
Title or Position	:	FRONT DEST
Name	:	JOSIE MILLARES
Credential	:
Telephone Number	:	954-239-0478

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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