Provider Demographics
NPI:1942232418
Name:BROWARD HEART GROUP P A
Entity Type:Organization
Organization Name:BROWARD HEART GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-344-8700
Mailing Address - Street 1:9800 W SAMPLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4039
Mailing Address - Country:US
Mailing Address - Phone:954-344-8700
Mailing Address - Fax:954-755-8138
Practice Address - Street 1:9800 W SAMPLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4039
Practice Address - Country:US
Practice Address - Phone:954-344-8700
Practice Address - Fax:954-755-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-11-19
Deactivation Date:2007-01-05
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
FLME003403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260971101Medicaid
FL260971101Medicaid