| Nsi Broward Llc | |
|
55 Weston Rd Ste 101b Weston FL 33326-1112 | |
| (954) 659-1208 | |
| Not Available |
| Full Name | Nsi Broward Llc |
|---|---|
| Speciality | General Practice |
| Location | 55 Weston Rd Ste 101b, Weston, Florida |
| Authorized Official Name and Position | Darran Hamm (OWNER) |
| Authorized Official Contact | 9544000479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nsi Broward Llc 55 Weston Rd Ste 101b Weston FL 33326-1112 Ph: (954) 659-1208 | Nsi Broward Llc 55 Weston Rd Ste 101b Weston FL 33326-1112 Ph: (954) 659-1208 |
| NPI Number | 1295203784 |
|---|---|
| Provider Enumeration Date | 11/02/2018 |
| Last Update Date | 08/02/2023 |
| Medicare PECOS PAC ID | 5092146779 |
|---|---|
| Medicare Enrollment ID | O20200513000933 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295203784 | NPI | - | NPPES |
| CH11011 | Other | FL | STATE OF FLORIDA |
| ME124453 | Other | FL | STATE OF FLORIDA |
| OS11815 | Other | FL | STATE OF FLORIDA |
| PA9104903 | Other | FL | STATE OF FLORIDA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Kyle H Petersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790032530 PECOS PAC ID: 8820233984 Enrollment ID: I20130321000211 |
| Provider Name | Darran Hamm |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1437354511 PECOS PAC ID: 5395825103 Enrollment ID: I20141023000010 |
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