1588697296 NPI number — WEST BOCA MEDICAL CENTER, INC.

Table of content: (NPI 1588697296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588697296 NPI number — WEST BOCA MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST BOCA MEDICAL CENTER, 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:
1588697296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-982-2189
Provider Business Mailing Address Fax Number:
561-488-8105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21644 STATE ROAD 7
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:
33428-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-488-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
461-488-8140

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  4283 , 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: 100268B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 758584410 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 291 . This is a "BCBS OF FLORIDA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 187244 . This is a "COVENTRY HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: WBOCA1000 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012024300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63583(HMO) . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6201580(NON-HMO) . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070030 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080086 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990366 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012024300 . 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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