Provider Demographics
NPI:1407228315
Name:AFFORDAHEALTH OF POMPANO LLC
Entity Type:Organization
Organization Name:AFFORDAHEALTH OF POMPANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGMR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-781-6908
Mailing Address - Street 1:50 NE 26TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5239
Mailing Address - Country:US
Mailing Address - Phone:954-781-6908
Mailing Address - Fax:954-781-6909
Practice Address - Street 1:50 NE 26TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5239
Practice Address - Country:US
Practice Address - Phone:954-781-6908
Practice Address - Fax:954-781-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty