Provider Demographics
NPI:1760997571
Name:BROWARD ONCOLOGY AND SICKLE CELL CENTER
Entity Type:Organization
Organization Name:BROWARD ONCOLOGY AND SICKLE CELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-623-7299
Mailing Address - Street 1:5324 SW 34TH WAY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5545
Mailing Address - Country:US
Mailing Address - Phone:954-623-7299
Mailing Address - Fax:954-525-3033
Practice Address - Street 1:1330 SE 4TH AVE STE J
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1958
Practice Address - Country:US
Practice Address - Phone:954-623-7299
Practice Address - Fax:954-525-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97695207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277439900Medicaid