Provider Demographics
NPI:1750057618
Name:PHYSICIANS OF TRADITIONAL CHINESE MEDICINE INC
Entity Type:Organization
Organization Name:PHYSICIANS OF TRADITIONAL CHINESE MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-760-2414
Mailing Address - Street 1:4300 N UNIVERSITY DR STE D100
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6243
Mailing Address - Country:US
Mailing Address - Phone:305-760-2414
Mailing Address - Fax:
Practice Address - Street 1:4300 N UNIVERSITY DR STE D100
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6243
Practice Address - Country:US
Practice Address - Phone:305-760-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty