Healthcare Provider Details

I. General information

NPI: 1003144601
Provider Name (Legal Business Name): PHYSICIAN EXTENDERS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N FEDERAL HWY SUITE 355
HALLANDALE BEACH FL
33009-2400
US

IV. Provider business mailing address

1001 N FEDERAL HWY SUITE 355
HALLANDALE BEACH FL
33009-2400
US

V. Phone/Fax

Practice location:
  • Phone: 954-455-5833
  • Fax: 866-902-8817
Mailing address:
  • Phone: 954-455-5833
  • Fax: 866-902-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK YAROSH
Title or Position: PRESIDENT
Credential: PA
Phone: 954-802-6864