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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1457899684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY
Second Line	:	SUITE D
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5572
Fax Number	:	954-985-7049

Provider Business Practice Location Address
First Line	:	16620 SHERIDAN ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33331-4128
Country	:	US
Telephone Number	:	954-265-3451
Fax Number	:	954-265-7747

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	06/29/2023

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