Provider Demographics
NPI:1093742678
Name:ADULT & GERIATRIC INSTITUTE OF FLORIDA INC
Entity Type:Organization
Organization Name:ADULT & GERIATRIC INSTITUTE OF FLORIDA INC
Other - Org Name:COURT OF PALM AIRE
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-489-1345
Mailing Address - Street 1:1608 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-489-1345
Mailing Address - Fax:
Practice Address - Street 1:COURT OF PALM AIRE
Practice Address - Street 2:2701 N COURSE DRIVE
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-489-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2303Medicare PIN