MEDICARE: E C MEDICAL INSTITUTE 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	261QM1300X	Multi-Specialty Clinic/Center	HCC 6589	FL

General Provider Information

NPI Number	:	1740290766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E C MEDICAL INSTITUTE INC

Provider Business Mailing Address
First Line	:	5340 N FEDERAL HWY
Second Line	:	SUITE 105
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-421-5474
Fax Number	:	954-421-5475

Provider Business Practice Location Address
First Line	:	5340 N FEDERAL HWY
Second Line	:	SUITE 105
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-421-5474
Fax Number	:	954-421-5475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERICH CORDERO
Credential	:
Telephone Number	:	954-421-5474

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	01/09/2008

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