Provider Demographics
NPI:1619318474
Name:MEDICAL PRACTITIONER HEALTHSYSTEMS, INC.
Entity Type:Organization
Organization Name:MEDICAL PRACTITIONER HEALTHSYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERSHORIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-432-1812
Mailing Address - Street 1:311 SW 99TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1065
Mailing Address - Country:US
Mailing Address - Phone:954-432-1812
Mailing Address - Fax:954-430-3261
Practice Address - Street 1:4217 SW 64TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3446
Practice Address - Country:US
Practice Address - Phone:954-432-1812
Practice Address - Fax:954-430-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty