Provider Demographics
NPI:1598535973
Name:PRINCE OF PEACE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PRINCE OF PEACE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SLABINE
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:MENELAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-278-2646
Mailing Address - Street 1:3370 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2216
Mailing Address - Country:US
Mailing Address - Phone:954-278-2646
Mailing Address - Fax:
Practice Address - Street 1:3370 NW 21ST CT
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2216
Practice Address - Country:US
Practice Address - Phone:954-278-2646
Practice Address - Fax:954-278-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service