Provider Demographics
NPI:1487897534
Name:WEST DIXIE HEALTH CENTER INC.
Entity type:Organization
Organization Name:WEST DIXIE HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:IDOLE
Authorized Official - Last Name:LAVENTURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-942-4299
Mailing Address - Street 1:703 S DIXIE HWY W
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8221
Mailing Address - Country:US
Mailing Address - Phone:954-942-4299
Mailing Address - Fax:954-942-4294
Practice Address - Street 1:703 S DIXIE HWY W
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8221
Practice Address - Country:US
Practice Address - Phone:954-942-4299
Practice Address - Fax:954-942-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-18
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003460200Medicaid