Provider Demographics
NPI:1134315773
Name:SOUTH FLORIDA NEUROSURGICAL INSTITUTE INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA NEUROSURGICAL INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-376-7330
Mailing Address - Street 1:7710 NW 71ST CT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2973
Mailing Address - Country:US
Mailing Address - Phone:954-376-7330
Mailing Address - Fax:954-720-2799
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-376-7330
Practice Address - Fax:954-720-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264899700Medicaid
CK2719OtherRAILROAD MEDICARE
FL97142OtherBLUE CROSS BLUE SHIELD
FL264899700Medicaid