Provider Demographics
NPI:1225378516
Name:JOHN BANCROFT HYLTON M.D,P.A
Entity Type:Organization
Organization Name:JOHN BANCROFT HYLTON M.D,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BANCROFT
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-252-0083
Mailing Address - Street 1:12323 SW 55TH ST
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3312
Mailing Address - Country:US
Mailing Address - Phone:954-252-0083
Mailing Address - Fax:954-252-0207
Practice Address - Street 1:12323 SW 55TH ST
Practice Address - Street 2:SUITE 1003
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3312
Practice Address - Country:US
Practice Address - Phone:954-252-0083
Practice Address - Fax:954-252-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060538261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374309800Medicaid
FL14931Medicare PIN
FL374309800Medicaid