NPIMap

Organization Active NPI

Phoenix Obstetrics and Gynecology LLC

  • Specialist
  • Fort Lauderdale, FL
National Provider Identifier
1902944382
Registry record updated May 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME43546 Issued in FL
Legal business name
PHOENIX OBSTETRICS AND GYNECOLOGY LLC
Practice address
1600 S Andrews Ave
Ft Lauderdale, FL 33316-2510
Phone
(954) 355-5017
Fax
(954) 714-6335
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2009

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

Authorized official

Name
Dr. Bertrum Walls, M.D.
Title
President
Phone
(954) 355-5017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X ME43546 FL Primary

Addresses

Primary practice location

1600 S Andrews Ave
Ft Lauderdale, FL 33316-2510

Mailing address

1600 S Andrews Ave
Rpicc Services
Ft Lauderdale, FL 33316-2510
Phone (954) 355-5017

Other identifiers 1

IdentifierTypeStateIssuer
269096902MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Obstetrics and Gynecology LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242950400000",
    "number": "1902944382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "address_2": "RPICC SERVICES",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-5017",
            "fax_number": "919-425-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-5017",
            "fax_number": "954-714-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX OBSTETRICS AND GYNECOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2009-05-22",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "BERTRUM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-355-5017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME43546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269096902",
            "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 May 22, 2009; 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.