Provider Demographics
NPI:1538367636
Name:NORTHWEST BROWARD NEUROSURGERY AND SPINE, LLC
Entity type:Organization
Organization Name:NORTHWEST BROWARD NEUROSURGERY AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-251-9995
Mailing Address - Street 1:111 JFK DR STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6634
Mailing Address - Country:US
Mailing Address - Phone:561-548-3716
Mailing Address - Fax:561-548-3878
Practice Address - Street 1:2960 N STATE ROAD 7
Practice Address - Street 2:SUITE 206
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5755
Practice Address - Country:US
Practice Address - Phone:561-548-3716
Practice Address - Fax:561-548-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99266207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH15611Medicare UPIN