Provider Demographics
NPI:1497773055
Name:NORTH BROWARD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTH BROWARD HOSPITAL DISTRICT
Other - Org Name:POMPANO ADULT PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-7315
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-786-5901
Mailing Address - Fax:954-786-0129
Practice Address - Street 1:2011 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4800
Practice Address - Country:US
Practice Address - Phone:954-786-5901
Practice Address - Fax:954-786-0129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BROWARD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00020OtherBCBS FL
FL060075003Medicaid
FL101840Medicare Oscar/Certification
FL00020Medicare PIN