MEDICARE: NORTH BROWARD RADIOLOGISTS, P.A.

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	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00019	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1417628884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BROWARD RADIOLOGISTS, P.A.

Provider Business Mailing Address
First Line	:	6330 N ANDREWS AVE STE 299
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2130
Country	:	US
Telephone Number	:	954-839-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1427
Country	:	US
Telephone Number	:	954-776-8750
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RICHIE HEATH
Credential	:
Telephone Number	:	407-310-7997

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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