Provider Demographics
NPI:1518550912
Name:AMARILLO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:AMARILLO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-261-9628
Mailing Address - Street 1:14750 NW 77TH CT STE 316
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1550
Mailing Address - Country:US
Mailing Address - Phone:786-261-9628
Mailing Address - Fax:786-829-2911
Practice Address - Street 1:14750 NW 77TH CT STE 316
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1550
Practice Address - Country:US
Practice Address - Phone:786-261-9628
Practice Address - Fax:786-829-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty