Provider Demographics
NPI:1710255567
Name:MEDIX FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:MEDIX FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-484-8444
Mailing Address - Street 1:2331 NORTH STATE ROAD 7
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-484-8444
Mailing Address - Fax:954-484-7784
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:SUITE 102
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3748
Practice Address - Country:US
Practice Address - Phone:954-484-8444
Practice Address - Fax:954-484-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304370300Medicaid