| La Clinique 300 Inc | |
|
2630 N Andrews Ave Wilton Manors FL 33311-2550 | |
| (954) 525-4900 | |
| (954) 396-3110 |
| Full Name | La Clinique 300 Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2630 N Andrews Ave, Wilton Manors, Florida |
| Authorized Official Name and Position | Joseph Fanfan (PRESIDENT) |
| Authorized Official Contact | 9545254900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Clinique 300 Inc 2630 N Andrews Ave Wilton Manors FL 33311-2550 Ph: (954) 525-4900 | La Clinique 300 Inc 2630 N Andrews Ave Wilton Manors FL 33311-2550 Ph: (954) 525-4900 |
| NPI Number | 1689059453 |
|---|---|
| Provider Enumeration Date | 07/22/2015 |
| Last Update Date | 05/09/2016 |
| Medicare PECOS PAC ID | 3779878137 |
|---|---|
| Medicare Enrollment ID | O20160824000913 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689059453 | NPI | - | NPPES |
| 068166100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME43065 (Florida) | Primary |
| Provider Name | Joseph Jr Fanfan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1265608616 PECOS PAC ID: 2567518764 Enrollment ID: I20090915000378 |
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