Provider Demographics
NPI:1992708887
Name:PHOENIX EMERGENCY MEDICINE OF BROWARD LLC
Entity type:Organization
Organization Name:PHOENIX EMERGENCY MEDICINE OF BROWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-450-4684
Mailing Address - Street 1:PO BOX 38048
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-0813
Mailing Address - Country:US
Mailing Address - Phone:954-939-5000
Mailing Address - Fax:484-342-5201
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-939-5000
Practice Address - Fax:484-342-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269118300Medicaid
FLK5350AMedicare ID - Type UnspecifiedBROWARD ED MEDICAREGRP#