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SACRED HEART MEDICAL OFFICE PA NPI 1609199017


NPI Information

NPI: 1609199017
Provider Name: SACRED HEART MEDICAL OFFICE PA
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
17901 NW 5TH ST
SUITE 205
PEMBROKE PINES, FL
ZIP 33029
Phone: (954) 392-0333
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SACRED HEART MEDICAL OFFICE PA is a clinic center in Pembroke Pines, FL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). SACRED HEART MEDICAL OFFICE PA NPI is 1609199017. The provider is registered as an organization entity type.

The provider's business location address is:

17901 NW 5TH ST
SUITE 205
PEMBROKE PINES, FL
ZIP 33029-810
Phone: (954) 392-0333
Fax: (954) 392-0393

The provider's authorized official is Yvelice A Villaman-bencosme .
The authorized official title is Owner and has the following contact phone number (954) 392-0333.

The enumeration date for this NPI number is 3/12/2010 and was last updated on 3/12/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterME64482FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1001454700MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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