Provider Demographics
NPI:1306833009
Name:SOUTH BROWARD ENDOSCOPY L L C
Entity type:Organization
Organization Name:SOUTH BROWARD ENDOSCOPY L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NODILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-435-0101
Mailing Address - Street 1:11011 SHERIDAN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1501
Mailing Address - Country:US
Mailing Address - Phone:954-435-0101
Mailing Address - Fax:954-435-0125
Practice Address - Street 1:11011 SHERIDAN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-1505
Practice Address - Country:US
Practice Address - Phone:954-435-0101
Practice Address - Fax:954-435-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000667580OtherAAAHC ORGANIZATION ID
10D1036818OtherCLIA WAIVER
FL1233OtherSTATE LICENSE
FL076062500Medicaid
FL6K9OtherBCBSFL
FL6K9OtherBCBSFL
FL076062500Medicaid