Provider Demographics
NPI:1932131380
Name:THE BROWARD HEART GROUP PA
Entity Type:Organization
Organization Name:THE BROWARD HEART GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALACCA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:954-344-8598
Mailing Address - Street 1:9800 W SAMPLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-344-8598
Mailing Address - Fax:954-344-8142
Practice Address - Street 1:8130 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-755-2320
Practice Address - Fax:954-344-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-08-21
Deactivation Date:2007-01-05
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45590COtherBCBS FL
FL45590CMedicare PIN