Provider Demographics
NPI:1730397555
Name:NORTH GENERAL CENTER OF MEDICINE
Entity type:Organization
Organization Name:NORTH GENERAL CENTER OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LAVENTURE
Authorized Official - Last Name:RENELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-414-6248
Mailing Address - Street 1:1325 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5876
Mailing Address - Country:US
Mailing Address - Phone:561-733-2929
Mailing Address - Fax:561-736-8467
Practice Address - Street 1:1325 S CONGRESS AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5802
Practice Address - Country:US
Practice Address - Phone:561-733-2929
Practice Address - Fax:561-736-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86189208D00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265955700Medicaid
FL265955700Medicaid