Provider Demographics
NPI:1013698604
Name:PRESTIGE MEDICAL CLINIC
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-702-5740
Mailing Address - Street 1:4699 N FEDERAL HWY # 209F-M
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6510
Mailing Address - Country:US
Mailing Address - Phone:954-800-6000
Mailing Address - Fax:954-302-8409
Practice Address - Street 1:4699 N FEDERAL HWY STE 209F-M
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6510
Practice Address - Country:US
Practice Address - Phone:954-800-6000
Practice Address - Fax:954-302-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care