MEDICARE: ACCESS MEDICAL CENTER, 'LLC'.

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

General Provider Information

NPI Number	:	1285068924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MEDICAL CENTER, 'LLC'.

Provider Business Mailing Address
First Line	:	5801 HALLANDALE BEACH BLVD STE 200
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-5243
Country	:	US
Telephone Number	:	305-748-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 HALLANDALE BEACH BLVD STE 200
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-5243
Country	:	US
Telephone Number	:	305-748-9310
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	GUYLENE BERRY
Credential	:
Telephone Number	:	305-748-9310

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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