NPIMap

Organization Active NPI

South Broward Surgical Group LLC

  • Specialist
  • Pembroke Pines, FL
National Provider Identifier
1619015658
Registry record updated Oct 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTH BROWARD SURGICAL GROUP LLC
Practice address
601 N Flamingo Rd
Suite 211
Pembroke Pines, FL 33028-1015
Phone
(954) 447-4480
Fax
(954) 447-5344
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2008

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

Authorized official

Name
Dr. Dexter C Sereda, M.D.NPI 1356337026
Title
Managing Partner
Phone
(954) 447-4480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

601 N Flamingo Rd
Suite 211
Pembroke Pines, FL 33028-1015

Mailing address

PO Box 260939
Pembroke Pines, FL 33026-7939
Phone (954) 447-4480

Other identifiers 1

IdentifierTypeStateIssuer
270575300MedicaidFL

National Provider Directory

National Provider Directory

Locations

603 N Flamingo Rd
Ste 258
Pembroke Pnes, FL 33028
Phone (954) 430-2343

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1619015658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260939",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330267939",
            "telephone_number": "954-447-4480",
            "fax_number": "954-447-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N FLAMINGO RD",
            "address_2": "SUITE 211",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281015",
            "telephone_number": "954-447-4480",
            "fax_number": "954-447-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD SURGICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "SEREDA",
        "authorized_official_first_name": "DEXTER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "954-447-4480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270575300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; 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.