Provider Demographics
NPI:1033716279
Name:VILLAGE MEDICAL CENTER, LLC.
Entity Type:Organization
Organization Name:VILLAGE MEDICAL CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-900-1466
Mailing Address - Street 1:13400 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1833
Mailing Address - Country:US
Mailing Address - Phone:954-900-1466
Mailing Address - Fax:954-900-1553
Practice Address - Street 1:13400 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1833
Practice Address - Country:US
Practice Address - Phone:954-900-1466
Practice Address - Fax:954-900-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty