Healthcare Provider Details

I. General information

NPI: 1902180391
Provider Name (Legal Business Name): SURGI-HEAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16437 NW 14TH ST
PEMBROKE PINES FL
33028-1316
US

IV. Provider business mailing address

16437 NW 14TH ST
PEMBROKE PINES FL
33028-1316
US

V. Phone/Fax

Practice location:
  • Phone: 954-944-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9073
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME90795
License Number StateFL

VIII. Authorized Official

Name: JOHN COTTRELL
Title or Position: PRESIDENT
Credential:
Phone: 954-944-2737