MEDICARE: GOTHRIG HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0800X	Psychiatry Physician
2	363LW0102X	Women's Health Nurse Practitioner
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1104485754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOTHRIG HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2862 BELLAROSA CIR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1462
Country	:	US
Telephone Number	:	757-613-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 N STATE ROAD 7 STE 207
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-3772
Country	:	US
Telephone Number	:	954-530-6558
Fax Number	:	954-769-1576

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EGLINTINE RIGAUD
Credential	:	APRN, PHD
Telephone Number	:	954-530-6558

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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