Provider Demographics
NPI:1710034376
Name:CHILDRENS MEDICAL CENTER
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-989-6000
Mailing Address - Street 1:4651 SHERIDAN ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3457
Mailing Address - Country:US
Mailing Address - Phone:954-989-6000
Mailing Address - Fax:954-378-4775
Practice Address - Street 1:4651 SHERIDAN ST
Practice Address - Street 2:SUITE 270
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3457
Practice Address - Country:US
Practice Address - Phone:954-989-6000
Practice Address - Fax:954-378-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14634302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060425900Medicaid