MEDICARE: COLORECTAL AND GI SPECIALISTS OF SOUTH FLORIDA, INC.

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	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1386671857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORECTAL AND GI SPECIALISTS OF SOUTH FLORIDA, INC.

Provider Business Mailing Address
First Line	:	150 SW 12TH AVE
Second Line	:	STE 201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3298
Country	:	US
Telephone Number	:	954-785-5530
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SW 12TH AVE
Second Line	:	STE 201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3298
Country	:	US
Telephone Number	:	954-785-5530
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN W. BEEBE
Credential	:
Telephone Number	:	954-785-5530

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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