Provider Demographics
NPI:1578691218
Name:DOCTORS PLUS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:DOCTORS PLUS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVEOFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-442-2828
Mailing Address - Street 1:501 NW 179TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2807
Mailing Address - Country:US
Mailing Address - Phone:954-442-2828
Mailing Address - Fax:954-442-3366
Practice Address - Street 1:501 NW 179TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2807
Practice Address - Country:US
Practice Address - Phone:954-442-2828
Practice Address - Fax:954-442-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL602678OtherDEPARTMENT OF HEALTH, DIVISION OF MEDICAL QALITY ASSURANCE
FL251887200Medicaid
FL251887200Medicaid