MEDICARE: PHYSICIAN CARE NETWORK, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	208D00000X	General Practice Physician
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1144470733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN CARE NETWORK, LLC

Provider Business Mailing Address
First Line	:	3114 COMMERCE PKWY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3943
Country	:	US
Telephone Number	:	954-331-6500
Fax Number	:	954-331-6699

Provider Business Practice Location Address
First Line	:	3114 COMMERCE PKWY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3943
Country	:	US
Telephone Number	:	954-331-6500
Fax Number	:	954-331-6699

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KENNETH NEDD
Credential	:
Telephone Number	:	954-331-6500

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	12/11/2008

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