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SOUTH BROWARD SURGICAL GROUP LLC NPI 1619015658


NPI Information

NPI: 1619015658
Provider Name: SOUTH BROWARD SURGICAL GROUP LLC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
601 N FLAMINGO RD
SUITE 211
PEMBROKE PINES, FL
ZIP 33028
Phone: (954) 447-4480
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SOUTH BROWARD SURGICAL GROUP LLC is a specialist in Pembroke Pines, FL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTH BROWARD SURGICAL GROUP LLC NPI is 1619015658. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

601 N FLAMINGO RD
SUITE 211
PEMBROKE PINES, FL
ZIP 33028-015
Phone: (954) 447-4480
Fax: (954) 447-5344

The provider's authorized official is Dexter C Sereda .
The authorized official title is Managing Partner and has the following contact phone number (954) 447-4480.

The enumeration date for this NPI number is 2/2/2007 and was last updated on 10/15/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D21138MEDICARE UPIN
2H28418MEDICARE UPIN
3H09315MEDICARE UPIN
4=========OTHERFLORIDATAX ID
5K5919MEDICARE ID-TYPE UNSPECIFIEDMEDICARE GROUP NUMBER
6270575300MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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