| Obsidian Healthcare Llc | |
|
3379 W Woolbright Rd Boynton Beach FL 33436-7245 | |
| (561) 449-0066 | |
| (561) 834-2511 |
| Full Name | Obsidian Healthcare Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3379 W Woolbright Rd, Boynton Beach, Florida |
| Authorized Official Name and Position | Jude Acloque (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 5614430066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Obsidian Healthcare Llc 3379 W Woolbright Rd Boynton Beach FL 33436-7245 Ph: (561) 449-0066 | Obsidian Healthcare Llc 3379 W Woolbright Rd Boynton Beach FL 33436-7245 Ph: (561) 449-0066 |
| NPI Number | 1447958699 |
|---|---|
| Provider Enumeration Date | 02/17/2023 |
| Last Update Date | 02/17/2023 |
| Medicare PECOS PAC ID | 6507211950 |
|---|---|
| Medicare Enrollment ID | O20231005000496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447958699 | NPI | - | NPPES |
| ME133297 | Other | FL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jude Andre Acloque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386085314 PECOS PAC ID: 7618237561 Enrollment ID: I20180214001168 |
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