# PEMBROKE PINES MEDICAL CENTER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588849723
- **Authorized official:** RICHARD A KOBY MD (VICE PRESIDENT)
- **Authorized official phone:** (305) 821-6600

## Contact information

- **Practice address:** 18219 PINES BLVD, PEMBROKE PINES, FL 33029-1417
- **Practice address phone:** (954) 436-1212
- **Practice address fax:** (954) 435-5444
- **Mailing address:** 18219 PINES BLVD, PEMBROKE PINES, FL 33029-1417
- **Mailing address phone:** (954) 436-1212
- **Mailing address fax:** (954) 435-5444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME49055 | FL | Yes |

## Other

- **Enumeration date:** 01/07/2008
- **Last updated:** 03/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000901 | NHP KOBY | FL |
| 01 | — | 001729 | NHP ZALIS | FL |
| 01 | — | 014686 | AVMED KOBY | FL |
| 01 | — | 02704 | BCBS KOBY | FL |
| 05 | — | 039823300 | — | FL |
| 05 | — | 044892300 | — | FL |
| 01 | — | 170130 | HUMANA | FL |
| 01 | — | 265997 | AVMED ZALIS | FL |
| 01 | — | 4337911 | AETNA KOBY | FL |
| 01 | — | 4521008 | AETNA ZALIS | FL |
| 01 | — | 6972300 | JMH ZALIS | FL |
| 01 | — | 7900000 | JMH KOBY | FL |
| 01 | — | 79162 | MCR ZALIS | FL |