Basic Information
| Provider Information | |||||||||
| NPI: | 1902841109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH BROWARD EKG ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 198469 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 303848469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547261808 | ||||||||
| FaxNumber: | 9547261820 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 EAST SAMPLE ROAD | ||||||||
| Address2: | EKG READERS PANEL | ||||||||
| City: | DEERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330643502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547261808 | ||||||||
| FaxNumber: | 9547261820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | DENNIS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9547850300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 277876900 | 05 | FL | MEDICAID |