Provider Demographics
NPI:1366015042
Name:UNIVIDA HALLANDALE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:UNIVIDA HALLANDALE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MEM
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMANN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-505-5009
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD STE QR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:954-505-5009
Mailing Address - Fax:786-677-0104
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE QR
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-505-5009
Practice Address - Fax:786-677-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty