Provider Demographics
NPI:1720328768
Name:THREE AMIGOS HEALTHCARE, INC
Entity Type:Organization
Organization Name:THREE AMIGOS HEALTHCARE, INC
Other - Org Name:SOUTH FLORIDA MEDICAL AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-252-3339
Mailing Address - Street 1:5931 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6110
Mailing Address - Country:US
Mailing Address - Phone:954-252-3339
Mailing Address - Fax:954-252-3315
Practice Address - Street 1:5931 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6110
Practice Address - Country:US
Practice Address - Phone:954-252-3339
Practice Address - Fax:954-252-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty