Provider Demographics
NPI:1124016266
Name:ANESCO NORTH BROWARD, LLC
Entity Type:Organization
Organization Name:ANESCO NORTH BROWARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-485-5666
Mailing Address - Street 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITES 4 & 5
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:6401 N FEDERAL HWY
Practice Address - Street 2:IMPERIAL POINT MEDICAL CENTER
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1405
Practice Address - Country:US
Practice Address - Phone:954-485-5666
Practice Address - Fax:954-484-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1054Medicare ID - Type Unspecified