Basic Information
| Provider Information | |||||||||
| NPI: | 1194093856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALMS WEST VEIN INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 486 | ||||||||
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| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334680486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617482889 | ||||||||
| FaxNumber: | 5617481523 | ||||||||
| Practice Location | |||||||||
| Address1: | 13005 SOUTHERN BLVD | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | LOXAHATCHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334709206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619078999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2011 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | BARLOW | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, JUPITER PROF DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 5617482889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | ME48674 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.