Provider Demographics
NPI:1013264985
Name:PW FAMILY LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:PW FAMILY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EPELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-613-9317
Mailing Address - Street 1:1404 EAST BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301
Mailing Address - Country:US
Mailing Address - Phone:954-463-7088
Mailing Address - Fax:954-463-8766
Practice Address - Street 1:1404 E. BROWARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:954-463-7088
Practice Address - Fax:954-463-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME007810261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257578700Medicaid