| Manor Plaza Pediatric Center Inc | |
|
1234 Ne 4th Ave Fort Lauderdale FL 33304-1925 | |
| (954) 779-1667 | |
| (954) 760-7253 |
| Full Name | Manor Plaza Pediatric Center Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 1234 Ne 4th Ave, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Jean-wilner Mathieu (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9547791667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manor Plaza Pediatric Center Inc 1234 Ne 4th Ave Fort Lauderdale FL 33304-1925 Ph: (954) 779-1667 | Manor Plaza Pediatric Center Inc 1234 Ne 4th Ave Fort Lauderdale FL 33304-1925 Ph: (954) 779-1667 |
| NPI Number | 1558657130 |
|---|---|
| Provider Enumeration Date | 06/22/2011 |
| Last Update Date | 02/16/2012 |
| Medicare PECOS PAC ID | 5193971000 |
|---|---|
| Medicare Enrollment ID | O20120808000937 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558657130 | NPI | - | NPPES |
| 062870100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME0042195 (Florida) | Secondary |
| 208000000X | Pediatrics | ME0042195 (Florida) | Primary |
| Provider Name | Jean- Wilner Mathieu |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629066980 PECOS PAC ID: 0547416455 Enrollment ID: I20120808000954 |
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