Provider Demographics
NPI:1184228975
Name:BROWARD INTEGRATIVE MEDICAL LLC
Entity Type:Organization
Organization Name:BROWARD INTEGRATIVE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAINFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:POYSER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:754-218-7163
Mailing Address - Street 1:1749 NE 26TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1428
Mailing Address - Country:US
Mailing Address - Phone:754-218-7163
Mailing Address - Fax:
Practice Address - Street 1:1749 NE 26TH ST STE E
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1428
Practice Address - Country:US
Practice Address - Phone:754-218-7163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWARD INTEGRATIVE MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty