MEDICARE: NORTH 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	208000000X	Pediatrics Physician
2	2080P0207X	Pediatric Hematology & Oncology Physician
3	2080P0205X	Pediatric Endocrinology Physician	ME134866	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00020	OTHER	FL	FLORIDA BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154797918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3763
Country	:	US
Telephone Number	:	954-888-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 W SAMPLE RD
Second Line	:	SUITE 505
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4045
Country	:	US
Telephone Number	:	954-888-3666
Fax Number	:	954-753-6377

Authorized Official
Title or Position	:	INTERIM CFO
Name	:	ALISA BERT
Credential	:
Telephone Number	:	954-847-4117

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	03/29/2024

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