1063466589 NPI number — COLUMBIA HOSPITAL CORPORATION OF SOUTH BROWARD

Table of content: (NPI 1063466589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063466589 NPI number — COLUMBIA HOSPITAL CORPORATION OF SOUTH BROWARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA HOSPITAL CORPORATION OF SOUTH BROWARD
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:
HCA FLORIDA WESTSIDE HOSPITAL
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:
1063466589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 W BROWARD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-473-6600
Provider Business Mailing Address Fax Number:
954-452-2133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 W BROWARD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-473-6600
Provider Business Practice Location Address Fax Number:
954-452-2133
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRZA
Authorized Official First Name:
IRFAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
954-476-3987

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5002025 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000030908 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00864411 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011230500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20237 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 281 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 011230500 . 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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