Provider Demographics
NPI:1780667923
Name:SOUTH BROWARD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH BROWARD HOSPITAL DISTRICT
Other - Org Name:MEMORIAL REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-276-5401
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5401
Mailing Address - Fax:954-602-2850
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-276-5401
Practice Address - Fax:954-602-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No273R00000XHospital UnitsPsychiatric UnitGroup - Multi-Specialty
No273Y00000XHospital UnitsRehabilitation UnitGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038184507Medicaid
FL360345801Medicaid
FL360345800Medicaid
FL010020000Medicaid
FL038184512Medicaid
FL038184519Medicaid
FL038184520Medicaid
FL360345800Medicaid
FL107444Medicare Oscar/Certification
FL360345801Medicaid
FL105668Medicare Oscar/Certification
FL100038Medicare Oscar/Certification
FL038184507Medicaid
FL10T038Medicare Oscar/Certification