MEDICARE: MACHI MED 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1376960930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACHI MED INC

Provider Business Mailing Address
First Line	:	2121 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3345
Country	:	US
Telephone Number	:	561-540-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3345
Country	:	US
Telephone Number	:	561-540-9777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LUIS MACHADO
Credential	:
Telephone Number	:	561-540-9777

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	03/20/2014

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