Provider Demographics
NPI:1902092950
Name:PDQ CARE INC
Entity Type:Organization
Organization Name:PDQ CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-341-9381
Mailing Address - Street 1:3130 NW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3534
Mailing Address - Country:US
Mailing Address - Phone:954-341-9381
Mailing Address - Fax:954-341-0641
Practice Address - Street 1:10300 W FOREST HILL BLVD
Practice Address - Street 2:SPACE 177
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3120
Practice Address - Country:US
Practice Address - Phone:561-793-1336
Practice Address - Fax:561-753-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ167Medicare PIN