Provider Demographics
NPI:1598092314
Name:INVICTUS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:INVICTUS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIZAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-967-4795
Mailing Address - Street 1:5920 JOHNSON ST
Mailing Address - Street 2:SUITE 108-110
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5652
Mailing Address - Country:US
Mailing Address - Phone:954-967-4795
Mailing Address - Fax:
Practice Address - Street 1:5920 JOHNSON ST
Practice Address - Street 2:SUITE 108-110
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5652
Practice Address - Country:US
Practice Address - Phone:954-967-4795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center