Medebra Inc

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

MEDEBRA INC

Doing business as

medebra inc

Practice address

2530 Okeechobee LN
Ft Lauderdale, FL 33312-4624

Phone

(954) 763-9479

Fax

(954) 712-2289

NPI assigned

Aug 16, 2010

Last updated

Aug 16, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kim Paucek Haley

Title

Owner

Phone

(954) 763-9479

Specialties & licenses 1

Addresses

Other names 1

• medebra inc Doing business as

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1326353269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 OKEECHOBEE LN",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333124624",
            "telephone_number": "954-763-9479",
            "fax_number": "954-712-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 OKEECHOBEE LN",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333124624",
            "telephone_number": "954-763-9479",
            "fax_number": "954-712-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEBRA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "PAUCEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-763-9479",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "medebra inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Preferred Provider Organization in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; 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.