Provider Demographics
NPI:1164813275
Name:ONYX MEDICAL CENTER, CORP
Entity Type:Organization
Organization Name:ONYX MEDICAL CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHENICKEA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-510-6890
Mailing Address - Street 1:3280 NW 103RD TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6102
Mailing Address - Country:US
Mailing Address - Phone:954-459-4097
Mailing Address - Fax:
Practice Address - Street 1:9900 W SAMPLE RD STE 310
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4048
Practice Address - Country:US
Practice Address - Phone:954-459-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory