| Shenandoah Medical Care Center | |
|
6234 S Congress Ave Suite F-1 Lantana FL 33462-2307 | |
| (561) 619-9510 | |
| Not Available |
| Full Name | Shenandoah Medical Care Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6234 S Congress Ave, Lantana, Florida |
| Authorized Official Name and Position | Joy L Fuller (OWNER) |
| Authorized Official Contact | 5618537233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shenandoah Medical Care Center Po Box 741424 Boynton Beach FL 33474-1424 Ph: () - | Shenandoah Medical Care Center 6234 S Congress Ave Suite F-1 Lantana FL 33462-2307 Ph: (561) 619-9510 |
| NPI Number | 1417494154 |
|---|---|
| Provider Enumeration Date | 01/19/2017 |
| Last Update Date | 01/19/2017 |
| Medicare PECOS PAC ID | 2961629829 |
|---|---|
| Medicare Enrollment ID | O20230712004163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417494154 | NPI | - | NPPES |
| 010866400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 2602122 (* (Not Available)) | Primary |
| Provider Name | Joy L Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720228208 PECOS PAC ID: 3072669795 Enrollment ID: I20090922000644 |
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