Provider Demographics
NPI:1063169084
Name:AMEN CLINICS INC, FLORIDA
Entity type:Organization
Organization Name:AMEN CLINICS INC, FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA SYSTEM SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:703-880-4000
Mailing Address - Street 1:200 S PARK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8351
Mailing Address - Country:US
Mailing Address - Phone:754-260-6000
Mailing Address - Fax:754-220-1776
Practice Address - Street 1:200 S PARK RD STE 140
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8351
Practice Address - Country:US
Practice Address - Phone:754-260-6000
Practice Address - Fax:754-220-1776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEN CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty