MEDICARE: SOUTH BROWARD HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PS0010X	Sports Medicine (Emergency Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134893852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY
Second Line	:	DOOR D
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5685
Fax Number	:	954-985-7074

Provider Business Practice Location Address
First Line	:	2122 W CYPRESS CREEK RD STE 220
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1868
Country	:	US
Telephone Number	:	954-265-8326
Fax Number	:	954-276-0021

Authorized Official
Title or Position	:	CFO MPG, MPC AND UCC
Name	:	ESTHER SURUJON
Credential	:
Telephone Number	:	954-265-6677

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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Directions to “SOUTH BROWARD HOSPITAL DISTRICT ” Practice Location

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