1770929044 NPI number — SURGCENTER OF PALM BEACH GARDENS

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 1770929044 NPI number — SURGCENTER OF PALM BEACH GARDENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGCENTER OF PALM BEACH GARDENS
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:
1770929044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 VILLAGE SQUARE CROSSING STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-4547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-429-6880
Provider Business Mailing Address Fax Number:
561-429-6881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 VILLAGE SQUARE CROSSING
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-429-6880
Provider Business Practice Location Address Fax Number:
561-429-6881
Provider Enumeration Date:
05/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LEMAISTRE
Authorized Official First Name:
COLLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
404-781-2921

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com