Provider Demographics
NPI:1093372260
Name:FED HELP MEDICAL OF WEST BROWARD, CORP
Entity Type:Organization
Organization Name:FED HELP MEDICAL OF WEST BROWARD, CORP
Other - Org Name:FED HELP MEDICAL BROWARD, CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-216-0796
Mailing Address - Street 1:2121 W OAKLAND PARK BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1507
Mailing Address - Country:US
Mailing Address - Phone:754-216-0796
Mailing Address - Fax:
Practice Address - Street 1:2121 W OAKLAND PARK BLVD STE 8
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1507
Practice Address - Country:US
Practice Address - Phone:754-216-0796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service