1619905668 NPI number — NORTH BROWARD HOSPITAL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619905668 NPI number — NORTH BROWARD HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BROWARD HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BH PHYSICIANS IMPERIAL POINT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619905668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 NW 49TH ST STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-3750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-771-7294
Provider Business Mailing Address Fax Number:
954-776-8956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-958-5220
Provider Business Practice Location Address Fax Number:
954-528-5218
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERT
Authorized Official First Name:
ALISA
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CFO
Authorized Official Telephone Number:
954-847-4117

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 253794018 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 253794018 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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