MEDICARE: LMC HEALTH & WELLNESS 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	ME64856	FL

General Provider Information

NPI Number	:	1316344740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LMC HEALTH & WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	9806 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024
Country	:	US
Telephone Number	:	786-597-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	9806 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6141
Country	:	US
Telephone Number	:	786-597-1585
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS M CAMPILLO
Credential	:
Telephone Number	:	786-597-1585

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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