1760997571 NPI number — BROWARD ONCOLOGY AND SICKLE CELL CENTER

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 1760997571 NPI number — BROWARD ONCOLOGY AND SICKLE CELL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWARD ONCOLOGY AND SICKLE CELL CENTER
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:
1760997571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5324 SW 34TH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33312-5545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-623-7299
Provider Business Mailing Address Fax Number:
954-525-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 SE 4TH AVE STE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-623-7299
Provider Business Practice Location Address Fax Number:
954-525-3033
Provider Enumeration Date:
12/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MAINI
Authorized Official First Name:
ARCHANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
954-623-7299

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  ME97695 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277439900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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