NPIMap

Organization Active NPI

Nova Southeastern University, Inc.

  • Family Medicine Physician
  • Davie, FL
National Provider Identifier
1780649194
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS2443 Issued in FL
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC.
Practice address
3200 S University Dr
Assembly Building II, Suite 202
Davie, FL 33328-2018
Phone
(954) 262-4399
Fax
(954) 262-1172
NPI assigned
Apr 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert S Oller, D.O.NPI 1811268626
Title
Ceo
Phone
(954) 262-4399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS2443 FL Primary

Addresses

Primary practice location

3200 S University Dr
Assembly Building II, Suite 202
Davie, FL 33328-2018

Mailing address

3200 S University Dr
Assembly Building II, Suite 202
Davie, FL 33328-2018
Phone (954) 262-4399

Other identifiers 1

IdentifierTypeStateIssuer
OS 2443OtherFLMEDICAL LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeastern Univ38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

3200 S University Dr
Bldg Ii
Davie, FL 33328
Phone (954) 262-4399

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780649194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "ASSEMBLY BUILDING II, SUITE 202",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4399",
            "fax_number": "954-262-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "ASSEMBLY BUILDING II, SUITE 202",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4399",
            "fax_number": "954-262-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-262-4399",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS2443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OS 2443",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.