Provider Demographics
NPI:1902028434
Name:SOUTH BROWARD NEPHROLOGY & HYPERTENSION ASSOCIATES PA
Entity Type:Organization
Organization Name:SOUTH BROWARD NEPHROLOGY & HYPERTENSION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GELDER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-364-4903
Mailing Address - Street 1:3700 WASHINGTON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-962-0338
Mailing Address - Fax:954-962-2357
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:SUITE 500
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-962-0338
Practice Address - Fax:954-962-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22201207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1529Medicare ID - Type UnspecifiedGROUP