Provider Demographics
NPI:1992117600
Name:BROWARD PALM MEDICAL CENTER 1, LLC
Entity type:Organization
Organization Name:BROWARD PALM MEDICAL CENTER 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CENTERS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-362-4173
Mailing Address - Street 1:6849 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5601
Mailing Address - Country:US
Mailing Address - Phone:305-913-7300
Mailing Address - Fax:305-362-4776
Practice Address - Street 1:6849 TAFT STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:303-913-7300
Practice Address - Fax:305-362-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN