1528076452 NPI number — SOUTH BROWARD HOSPITAL DISTRICT

Table of content: (NPI 1528076452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528076452 NPI number — SOUTH BROWARD HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH 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:
MEMORIAL DIVISION OF BREAST SURGICAL ONCOLOGY
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:
1528076452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 CORPORATE WAY
Provider Second Line Business Mailing Address:
DOOR D
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-276-5685
Provider Business Mailing Address Fax Number:
954-985-7074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 N 35TH AVE STE 170
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-265-4325
Provider Business Practice Location Address Fax Number:
954-985-2451
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAUCHESNE
Authorized Official First Name:
NINA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
954-265-3451

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038184531 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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