Provider Demographics
NPI:1992375281
Name:AMICUS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:AMICUS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HERIKA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-505-5000
Mailing Address - Street 1:1300 CONCORD TER STE 210
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2899
Mailing Address - Country:US
Mailing Address - Phone:954-505-5000
Mailing Address - Fax:954-838-9660
Practice Address - Street 1:3795 W BOYNTON BEACH BLVD STE D
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4502
Practice Address - Country:US
Practice Address - Phone:561-738-7900
Practice Address - Fax:561-369-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric