MEDICARE: POMPANO ER PEDIATRICS LLC

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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	ME39895	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669475349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMPANO ER PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	3114 CROASDAILE DR STE 200
Second Line	:	POMPANO ER PEDIATRICS LLC
City	:	DURHAM
State	:	NC
Zip	:	27705-2508
Country	:	US
Telephone Number	:	919-425-1565
Fax Number	:	919-425-0478

Provider Business Practice Location Address
First Line	:	201 E SAMPLE RD
Second Line	:	POMPANO ER PEDIATRICS
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3502
Country	:	US
Telephone Number	:	954-768-6800
Fax Number	:	919-425-0478

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. STEVEN M SCOTT
Credential	:	MD
Telephone Number	:	919-425-1565

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/27/2009

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