Provider Demographics
NPI:1497068472
Name:AMCA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:AMCA MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-922-7400
Mailing Address - Street 1:1610 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2306
Mailing Address - Country:US
Mailing Address - Phone:954-922-7400
Mailing Address - Fax:954-925-1327
Practice Address - Street 1:1610 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2306
Practice Address - Country:US
Practice Address - Phone:954-922-7400
Practice Address - Fax:954-925-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051678261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ253AMedicare PIN