Provider Demographics
NPI:1124430319
Name:NORTH BROWARD HOSPITAL DISTRICT
Entity type:Organization
Organization Name:NORTH BROWARD HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-847-4117
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-759-7477
Mailing Address - Fax:
Practice Address - Street 1:5430 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3453
Practice Address - Country:US
Practice Address - Phone:954-759-7477
Practice Address - Fax:954-969-8055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BROWARD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259612104Medicaid
FL259612104Medicaid