1346507837 NPI number — CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC

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 1346507837 NPI number — CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC
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:
6
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:
1346507837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4623 FOREST HILL BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-967-8888
Provider Business Mailing Address Fax Number:
561-641-8303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1903 PORT ST. LUCIE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-467-2677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEGER
Authorized Official First Name:
RUSS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-967-8888

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH5626 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME81066 , 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)