MEDICARE: CMS FT. LAUDERDALE

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700857208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMS FT. LAUDERDALE

Provider Business Mailing Address
First Line	:	1625 SE 3RD AVE
Second Line	:	SUITE 415
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2521
Country	:	US
Telephone Number	:	954-713-3105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 SE 3RD AVE
Second Line	:	SUITE 415
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2521
Country	:	US
Telephone Number	:	954-713-3105
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MRS. JOYCE RAMEY-KANTOR
Credential	:
Telephone Number	:	954-713-3105

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	08/22/2020

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