Provider Demographics
NPI:1679900930
Name:HOUSECALLS EXPRESS OF BROWARD, LLC
Entity Type:Organization
Organization Name:HOUSECALLS EXPRESS OF BROWARD, LLC
Other - Org Name:HOUSECALLS EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:HULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:772-781-2207
Mailing Address - Street 1:1241 SE INDIAN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5675
Mailing Address - Country:US
Mailing Address - Phone:772-781-2207
Mailing Address - Fax:888-831-3522
Practice Address - Street 1:3109 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5148
Practice Address - Country:US
Practice Address - Phone:954-727-9550
Practice Address - Fax:954-727-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty