MEDICARE: SOUTH BROWARD ENDOSCOPY L L C

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000667580	OTHER	FL	AAAHC ORGANIZATION ID
2	10D1036818	OTHER		CLIA WAIVER
3	1233	OTHER	FL	STATE LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	6K9	OTHER	FL	BCBSFL
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306833009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BROWARD ENDOSCOPY L L C

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST STE 106
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1501
Country	:	US
Telephone Number	:	954-435-0101
Fax Number	:	954-435-0125

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST
Second Line	:	SUITE 106
City	:	COOPER CITY
State	:	FL
Zip	:	33026-1505
Country	:	US
Telephone Number	:	954-435-0101
Fax Number	:	954-435-0125

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NODILEE JAMES
Credential	:
Telephone Number	:	954-435-0101

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	11/04/2025

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Directions to “SOUTH BROWARD ENDOSCOPY L L C ” Practice Location

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