MEDICARE: INSTANT MEDICAL CARE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1376852566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTANT MEDICAL CARE CENTER INC

Provider Business Mailing Address
First Line	:	1318 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-200-6001
Fax Number	:	561-953-4156

Provider Business Practice Location Address
First Line	:	1318 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-200-6001
Fax Number	:	561-953-4156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GILBERT MEDIDA
Credential	:	PA
Telephone Number	:	954-200-6001

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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