MEDICARE: NORTH BROWARD HOSPITAL DISTRICT

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00020	OTHER	FL	BCBS OF FLA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1811925886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1608 SE 3RD AVE FL 3
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2564
Country	:	US
Telephone Number	:	954-759-6710
Fax Number	:	954-759-6767

Provider Business Practice Location Address
First Line	:	200 NW 7TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9026
Country	:	US
Telephone Number	:	954-759-6600
Fax Number	:	954-759-6767

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/28/2025

200 NW 7TH AVE , PHOENIX EMERGENCY MEDICINE OF BROWARD, LLC
FORT LAUDERDALE, FL
33311-9026

Practice Phone: 954-759-6793
Practice Fax: