Provider Demographics
NPI:1770511727
Name:NORTH BROWARD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTH BROWARD HOSPITAL DISTRICT
Other - Org Name:BH PHYSICIANS MAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-847-4117
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-462-8323
Mailing Address - Fax:954-463-1149
Practice Address - Street 1:2866 E OAKLAND PARK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1819
Practice Address - Country:US
Practice Address - Phone:954-462-8323
Practice Address - Fax:954-463-1149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BROWARD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00020OtherBCBS
FL253794010Medicaid
FL253794010Medicaid