Provider Demographics
NPI: | 1518232065 |
---|---|
Name: | SCA DERMATOLOGY, LLC |
Entity Type: | Organization |
Organization Name: | SCA DERMATOLOGY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD / PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | S, |
Authorized Official - Last Name: | GREENE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 954-473-6750 |
Mailing Address - Street 1: | 1111 PARK CENTRE BLVD |
Mailing Address - Street 2: | S. 300 |
Mailing Address - City: | MIAMI GARDENS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33169-5365 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-623-5595 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 915 W MONROE ST |
Practice Address - Street 2: | S. 101 |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32204-1177 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-903-4345 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SKIN AND CANCER ASSOCIATES, LLP |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2012-03-16 |
Last Update Date: | 2017-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | Group - Single Specialty |