Provider Demographics
NPI:1346479664
Name:FORT LAUDERDALE WOMENS CENTER LLC
Entity Type:Organization
Organization Name:FORT LAUDERDALE WOMENS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:954-733-0121
Mailing Address - Street 1:2001 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1521
Mailing Address - Country:US
Mailing Address - Phone:954-733-0121
Mailing Address - Fax:954-733-3870
Practice Address - Street 1:2001 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1521
Practice Address - Country:US
Practice Address - Phone:954-733-0121
Practice Address - Fax:954-733-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty