=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285646547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWARD INSTITUTE OF ORTHOPAEDIC SPECIALTIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4310 SHERIDAN ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-989-3500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4440 SHERIDAN ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-962-3508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY WORTH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-962-3508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------