MEDICARE: THREE AMIGOS HEALTHCARE, 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	207Q00000X	Family Medicine Physician	ME90210	FL

General Provider Information

NPI Number	:	1720328768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE AMIGOS HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	5931 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-6110
Country	:	US
Telephone Number	:	954-252-3339
Fax Number	:	954-252-3315

Provider Business Practice Location Address
First Line	:	5931 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-6110
Country	:	US
Telephone Number	:	954-252-3339
Fax Number	:	954-252-3315

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. DAVID SCHWARTZ
Credential	:	D.C.
Telephone Number	:	954-252-3339

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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