Healthcare Provider Details

I. General information

NPI: 1588907695
Provider Name (Legal Business Name): BROWARD OUTPATIENT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S ANDREWS AVE SUITE 201
POMPANO BEACH FL
33069-3298
US

IV. Provider business mailing address

150 S ANDREWS AVE SUITE 201
POMPANO BEACH FL
33069-3298
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-2969
  • Fax: 954-960-6858
Mailing address:
  • Phone: 954-941-2969
  • Fax: 954-960-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY B CASTROVINCI
Title or Position: DIRECTOR OF OPERATIONS
Credential: R.N.
Phone: 954-941-2969