Provider Demographics
NPI:1558393041
Name:BROWARD HEART GROUP P A
Entity Type:Organization
Organization Name:BROWARD HEART GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-344-8700
Mailing Address - Street 1:9800 W SAMPLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-344-8598
Mailing Address - Fax:954-344-8142
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-721-6666
Practice Address - Fax:954-726-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-16
Deactivation Date:2007-01-05
Deactivation Code:
Reactivation Date:2007-08-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45590BOtherBCBS OF FL GROUP
FL260971102Medicaid
FL45590BMedicare PIN