1902841109 NPI number — NORTH BROWARD EKG ASSOCIATES INC

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 1902841109 NPI number — NORTH BROWARD EKG ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BROWARD EKG ASSOCIATES INC
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:
Provider Other Organization Name Type Code:
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:
1902841109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
30384-8469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-726-1808
Provider Business Mailing Address Fax Number:
954-726-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 EAST SAMPLE ROAD
Provider Second Line Business Practice Location Address:
EKG READERS PANEL
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-726-1808
Provider Business Practice Location Address Fax Number:
954-726-1820
Provider Enumeration Date:
06/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-785-0300

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277876900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".