Provider Demographics
NPI:1659416188
Name:NORTHWEST BROWARD ORTHOPAEDIC ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTHWEST BROWARD ORTHOPAEDIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORAINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-935-9955
Mailing Address - Street 1:5901 COLONIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5675
Mailing Address - Country:US
Mailing Address - Phone:954-935-9955
Mailing Address - Fax:954-935-0674
Practice Address - Street 1:5901 COLONIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5675
Practice Address - Country:US
Practice Address - Phone:954-935-9955
Practice Address - Fax:954-935-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40539OtherBCBS OF FLORIDA
FL40539Medicare ID - Type Unspecified
FL40539OtherBCBS OF FLORIDA