1982768941 NPI number — PALM BEACH ORTHOPAEDIC ASSOCIATES, L.L.C.

Table of content: (NPI 1982768941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982768941 NPI number — PALM BEACH ORTHOPAEDIC ASSOCIATES, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM BEACH ORTHOPAEDIC ASSOCIATES, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELITE ORTHOPAEDIC ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982768941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2580 METROCENTRE BLVD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-684-2022
Provider Business Mailing Address Fax Number:
561-478-7921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2580 METROCENTRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-684-2022
Provider Business Practice Location Address Fax Number:
561-478-7921
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOSS
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
561-627-2821

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0371181-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011R . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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