MEDICARE: BOCA GENERAL AND FAMILY MEDICINE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1174145650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOCA GENERAL AND FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	1500 NW 10TH AVE STE 101
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-1344
Country	:	US
Telephone Number	:	561-391-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NW 10TH AVE STE 101
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-1344
Country	:	US
Telephone Number	:	561-391-2708
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JENNIFER ELENA BINETTE
Credential	:
Telephone Number	:	561-391-2708

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/07/2020

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Directions to “BOCA GENERAL AND FAMILY MEDICINE ” Practice Location

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