| Univida Hallandale Medical Center Llc | |
|
2500 E Hallandale Beach Blvd Ste Qr Hallandale Beach FL 33009-4834 | |
| (954) 505-5009 | |
| (786) 677-0104 |
| Full Name | Univida Hallandale Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2500 E Hallandale Beach Blvd Ste Qr, Hallandale Beach, Florida |
| Authorized Official Name and Position | Hermann J Lange (SR MEM) |
| Authorized Official Contact | 9545055009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Univida Hallandale Medical Center Llc 2500 E Hallandale Beach Blvd Ste Qr Hallandale Beach FL 33009-4834 Ph: (954) 505-5009 | Univida Hallandale Medical Center Llc 2500 E Hallandale Beach Blvd Ste Qr Hallandale Beach FL 33009-4834 Ph: (954) 505-5009 |
| NPI Number | 1366015042 |
|---|---|
| Provider Enumeration Date | 07/21/2021 |
| Last Update Date | 09/16/2024 |
| Medicare PECOS PAC ID | 5193117307 |
|---|---|
| Medicare Enrollment ID | O20220120002347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366015042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Ruben Bembibre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689962672 PECOS PAC ID: 7911206479 Enrollment ID: I20160527000388 |
| Provider Name | Sergio Hernandez Borges |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043600414 PECOS PAC ID: 7012203458 Enrollment ID: I20161119000046 |
| Provider Name | Thomas A Marin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215306782 PECOS PAC ID: 8729452271 Enrollment ID: I20230323001156 |
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