Healthcare Provider Details

I. General information

NPI: 1891847471
Provider Name (Legal Business Name): HALLANDALE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SE 1ST AVE
HALLANDALE BEACH FL
33009-7102
US

IV. Provider business mailing address

815 SE 1ST AVE
HALLANDALE BEACH FL
33009-7102
US

V. Phone/Fax

Practice location:
  • Phone: 954-455-1668
  • Fax: 954-455-1669
Mailing address:
  • Phone: 954-455-1668
  • Fax: 954-455-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberOS 8808
License Number StateFL

VIII. Authorized Official

Name: DR. MARK LAWRENCE SCHWARTZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-455-1668