NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Pediatric Dermatology

  • Dermatology Physician
  • Hollywood, FL
National Provider Identifier
1245621697
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Pediatric Dermatology
Practice address
1150 N 35TH Ave
Suite 495
Hollywood, FL 33021-5424
Phone
(954) 265-7546
NPI assigned
Feb 6, 2015
Last updated
Feb 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nina Beauchesne
Title
Sr Vice President MHS
Phone
(954) 265-6996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1150 N 35TH Ave
Suite 495
Hollywood, FL 33021-5424

Mailing address

2900 Corporate Way
MPG Door D
Miramar, FL 33025-3925
Phone (954) 276-5681

Other names 1

  • MEMORIAL DIVISION OF PEDIATRIC DERMATOLOGY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1245621697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "MPG DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE",
            "address_2": "SUITE 495",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215424",
            "telephone_number": "954-265-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-06",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "BEAUCHESNE",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "SR VICE PRESIDENT MHS",
        "authorized_official_telephone_number": "954-265-6996"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL DIVISION OF PEDIATRIC DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.