| Iatac | |
|
4101 S Hospital Dr Plantation FL 33317-2857 | |
| (954) 999-0818 | |
| (954) 999-0947 |
| Full Name | Iatac |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4101 S Hospital Dr, Plantation, Florida |
| Authorized Official Name and Position | Suzanne Lutz (ADMINISTRATOR) |
| Authorized Official Contact | 9547423802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iatac 4101 S Hospital Dr Ste 15 Plantation FL 33317-2830 Ph: (549) 999-0818 | Iatac 4101 S Hospital Dr Plantation FL 33317-2857 Ph: (954) 999-0818 |
| NPI Number | 1003190406 |
|---|---|
| Provider Enumeration Date | 10/04/2011 |
| Last Update Date | 12/09/2022 |
| Certification Date | 12/09/2022 |
| Medicare PECOS PAC ID | 0840602868 |
|---|---|
| Medicare Enrollment ID | O20201216002181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003190406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
| Provider Name | Pierre E Pean |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710013990 PECOS PAC ID: 9931367596 Enrollment ID: I20120228000693 |
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