NPIMap

Organization Active NPI

Amen Clinics Inc, Florida

  • Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
  • Hollywood, FL
National Provider Identifier
1063169084
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianTaxonomy code 2084D0003X
Legal business name
AMEN CLINICS INC, FLORIDA
Practice address
200 S Park Rd Ste 140
Hollywood, FL 33021-8351
Phone
(754) 260-6000
Fax
(754) 220-1776
NPI assigned
Mar 9, 2022
Last updated
Mar 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
AMEN CLINICS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christina T McCormick, MS
Title
Data System Specialist
Phone
(703) 880-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician 2084D0003X Primary

Addresses

Primary practice location

200 S Park Rd Ste 140
Hollywood, FL 33021-8351

Mailing address

200 S Park Rd Ste 140
Hollywood, FL 33021-8351
Phone (754) 260-6000

National Provider Directory

National Provider Directory
Tax ID family
Amen Clinics Inc Dallas11 organizations share this tax ID, including this one
Part of
Amen Clinics Inc Dallas

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 S Park Rd
Ste 140
Hollywood, FL 33021
Phone (754) 260-6000

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1063169084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S PARK RD STE 140",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218351",
            "telephone_number": "754-260-6000",
            "fax_number": "754-220-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S PARK RD STE 140",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218351",
            "telephone_number": "754-260-6000",
            "fax_number": "754-220-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMEN CLINICS INC, FLORIDA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMEN CLINICS, INC",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DATA SYSTEM SPECIALIST",
        "authorized_official_telephone_number": "703-880-4000",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "2084D0003X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Diagnostic Neuroimaging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.