Provider Demographics
NPI:1457480691
Name:SOUTH FLORIDA MEDICAL CENTERS INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA MEDICAL CENTERS INC
Other - Org Name:AMICUS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-505-5000
Mailing Address - Street 1:14201 W SUNRISE BLVD
Mailing Address - Street 2:UNIT 207
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-505-5000
Mailing Address - Fax:754-200-8959
Practice Address - Street 1:14201 W. SUNRISEBLVD
Practice Address - Street 2:UNIT 207
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-505-5000
Practice Address - Fax:954-756-4442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMICUS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208000000X
FLHCC9561261QP2300X
FLHC9560261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260924002Medicaid
FLK1476AOtherMEDICARE
FLK1476OtherMEDICARE
FL260924001Medicaid