UNIVIDA HALLANDALE MEDICAL CENTER LLC
NPI 1366015042
Family Medicine - Adult Medicine in Hallandale Beach, FL

Q: What is Univida Hallandale Medical Center LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Active since July 21, 2021CLIA 10D2233282 · Waiver

2500 E HALLANDALE BEACH BLVD STE QR, HALLANDALE BEACH, FL 33009(954) 505-5009(786) 677-0104 Get Directions Write a Review

NPPES record last updated: September 16, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 16, 2024, Jul 21, 2021 (2 updates tracked since 2021).

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About Univida Hallandale Medical Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

UNIVIDA HALLANDALE MEDICAL CENTER LLC (NPI 1366015042) is a healthcare organization registered as an adult medicine in Hallandale Beach, Florida and active in the NPI registry since July 2021. The organization holds a CLIA Waiver certificate valid through August 22, 2027 and lists Hermann J Lange, Sr Mem, as its authorized official.

NPPES Registry Identity

NPI1366015042

Entity TypeOrganization

Primary Taxonomy207QA0505X

Legal Business NameUNIVIDA HALLANDALE MEDICAL CENTER LLC

Location Address2500 E HALLANDALE BEACH BLVD STE QRHallandale Beach, FL 33009-4834

Mailing Address2500 E Hallandale Beach Blvd Ste QrHallandale Beach, FL 33009-4834 · (954) 505-5009 · Fax (786) 677-0104

Phone(954) 505-5009

Fax(786) 677-0104

Organization SubpartNo

Authorized OfficialHermann J LangeSr Mem · (954) 505-5009

Enumeration DateJuly 21, 2021

Last NPPES UpdateSeptember 16, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 16, 2024

✔ NPI 1366015042 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0505X

Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

2500 E HALLANDALE BEACH BLVD STE QR, Hallandale Beach, FL 33009

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2233282

Univida Hallandale Medical Center, LLC · Hallandale Beach, FL

Active · expires Aug 22, 2027

CLIA Number10D2233282

Laboratory TypePhysician Office

Certificate Effective DateAugust 23, 2025

Certificate Expiration DateAugust 22, 2027

Laboratory DirectorRuben Bembibre

Laboratory Phone(954) 505-5009

Laboratory LocationUnivida Hallandale Medical Center, LLC2500 E Hallandale Beach Blvd, Suite Q, Hallandale Beach, FL 33009

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ARIEL AMADOR GONZALEZ FNP

Nurse Practitioner (Family)