=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770511727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH BROWARD HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 04/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2866 E OAKLAND PARK BLVD STE 2
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33306-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-462-8323
-----------------------------------------------------
Fax | 954-463-1149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 NW 49TH ST STE 125
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-462-8323
-----------------------------------------------------
Fax | 954-463-1149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM CFO
-----------------------------------------------------
Name | ALISA BERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-847-4117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------