1174145650 NPI number — BOCA GENERAL AND FAMILY MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174145650 NPI number — BOCA GENERAL AND FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOCA GENERAL AND FAMILY MEDICINE
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:
Provider Other Organization Name Type Code:
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:
1174145650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 NW 10TH AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33486-1344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-391-2708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 NW 10TH AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33486-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-391-2708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BINETTE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
561-391-2708

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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