1457326761 NPI number — CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.

Table of content: (NPI 1457326761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457326761 NPI number — CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.
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:
1457326761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/25/2018
NPI Reactivation Date:
08/17/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10131 FOREST HILL BLVD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-803-8616
Provider Business Mailing Address Fax Number:
561-615-1956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10131 W FOREST HILL BLVD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-803-8616
Provider Business Practice Location Address Fax Number:
561-615-1958
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTIJO
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-798-6600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013574700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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