MEDICARE: MEDICAL CENTER FOR CHILDREN, P.A.

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	208000000X	Pediatrics Physician	ME74443	FL

General Provider Information

NPI Number	:	1841512837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER FOR CHILDREN, P.A.

Provider Business Mailing Address
First Line	:	8198 JOG RD
Second Line	:	SUITE 102B
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2900
Country	:	US
Telephone Number	:	561-736-2292
Fax Number	:	561-274-0021

Provider Business Practice Location Address
First Line	:	8198 JOG RD
Second Line	:	SUITE 102B
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2900
Country	:	US
Telephone Number	:	561-736-2292
Fax Number	:	561-274-0021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLINE ST. LOUIS-MOISE
Credential	:	MD
Telephone Number	:	561-736-2292

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	03/12/2010

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