Organization
SOUTH BROWARD ENDOSCOPY L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NODILEE JAMES (ADMINISTRATOR)
(954) 435-0101
Entity
Organization
Contact information
Practice address
11011 SHERIDAN ST, SUITE 106, COOPER CITY, FL 33026-1505
(954) 435-0101
(954) 435-0125
Mailing address
11011 SHERIDAN ST STE 106, HOLLYWOOD, FL 33026-1501
(954) 435-0101
(954) 435-0125
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000667580
AAAHC ORGANIZATION ID
FL
05
—
076062500
—
FL
01
—
10D1036818
CLIA WAIVER
—
01
—
1233
STATE LICENSE
FL
01
—
6K9
BCBSFL
FL
Enumeration date
09/29/2005
Last updated
11/04/2025
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