1831391788 NPI number — SPINAL DECOMPRESSION CENTER OF THE PALM BEACHES, LLP

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 1831391788 NPI number — SPINAL DECOMPRESSION CENTER OF THE PALM BEACHES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINAL DECOMPRESSION CENTER OF THE PALM BEACHES, LLP
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:
1831391788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32962-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-234-3833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12300 HIGHWAY A1A ALT
Provider Second Line Business Practice Location Address:
SUITE 110
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:
33410-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-630-3033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
TED
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
772-234-3833

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0003905 , 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)





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