Provider Demographics
NPI:1356664445
Name:IHS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:IHS MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:954-726-1662
Mailing Address - Street 1:7800 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2128
Mailing Address - Country:US
Mailing Address - Phone:954-726-1662
Mailing Address - Fax:954-726-1678
Practice Address - Street 1:7800 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101-102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2128
Practice Address - Country:US
Practice Address - Phone:954-726-1662
Practice Address - Fax:954-726-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty