Provider Demographics
NPI:1568030138
Name:SOUTH BROWARD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH BROWARD HOSPITAL DISTRICT
Other - Org Name:MEMORIAL DIVISION OF PEDIATRIC REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO MEMORIAL PHYSICIAN GROUP & MPC
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-265-6677
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3377 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8082
Practice Address - Country:US
Practice Address - Phone:954-276-1600
Practice Address - Fax:954-893-6244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BROWARD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-11
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty