NPIMap

Organization Active NPI

Phoenix Obstetrics and Gynecology LLC

  • Obstetrics & Gynecology Physician
  • Fort Lauderdale, FL
National Provider Identifier
1285637066
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME43546 Issued in FL
Legal business name
PHOENIX OBSTETRICS AND GYNECOLOGY LLC
Practice address
1600 S Andrews Ave
Suite 323, West Wing
Ft Lauderdale, FL 33316-2510
Phone
(954) 355-5110
Fax
(919) 425-0478
NPI assigned
May 24, 2005
Last updated
Jul 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Authorized official

Name
Kathy Kondas
Title
Officer
Phone
(877) 328-1119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME43546 FL Primary

Addresses

Primary practice location

1600 S Andrews Ave
Suite 323, West Wing
Ft Lauderdale, FL 33316-2510

Mailing address

5565 Centerview Dr Ste 107
Raleigh, NC 27606-3563

Other identifiers 1

IdentifierTypeStateIssuer
269096900MedicaidFL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1285637066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 CENTERVIEW DR STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063563",
            "fax_number": "919-425-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "address_2": "SUITE 323, WEST WING",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-5110",
            "fax_number": "919-425-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX OBSTETRICS AND GYNECOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "877-328-1119"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME43546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269096900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.