MEDICARE: BROWARD SURGICAL SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	RN9216868	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN9216868	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1245627405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD SURGICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	16900 N BAY RD
Second Line	:	SUITE 1401
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4252
Country	:	US
Telephone Number	:	954-416-1781
Fax Number	:	954-416-1782

Provider Business Practice Location Address
First Line	:	16900 N BAY RD
Second Line	:	SUITE 1401
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4252
Country	:	US
Telephone Number	:	954-416-1781
Fax Number	:	954-416-1782

Authorized Official
Title or Position	:	PD
Name	:	RONALDO VALENCIA
Credential	:	RNFA
Telephone Number	:	954-416-1781

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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