Provider Demographics
NPI:1487634556
Name:SAMUEL G SCIME MD PA
Entity Type:Organization
Organization Name:SAMUEL G SCIME MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCIME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-721-8330
Mailing Address - Street 1:7401 NORTH UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2919
Mailing Address - Country:US
Mailing Address - Phone:954-721-8330
Mailing Address - Fax:954-721-8330
Practice Address - Street 1:7401 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2919
Practice Address - Country:US
Practice Address - Phone:954-721-8330
Practice Address - Fax:954-721-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15470207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51717Medicare UPIN
FL06800Medicare ID - Type Unspecified