Provider Demographics
NPI:1366499618
Name:BROWARD NEUROSURGEONS LLC
Entity Type:Organization
Organization Name:BROWARD NEUROSURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TEDRICK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-3375
Mailing Address - Street 1:8251 W BROWARD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:954-475-9244
Mailing Address - Fax:954-475-0848
Practice Address - Street 1:8251 W BROWARD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-475-9244
Practice Address - Fax:954-475-0848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWARD NEUROSURGEONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0753OtherRAILROAD
FL34411OtherBLUE CROSS/BLUE SHIELD OF
FL34411Medicare PIN
FL5406170001Medicare NSC