Basic Information
| Provider Information | |||||||||
| NPI: | 1225591084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PCP SPECIALISTS OF THE PALM BEACHES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 LAKE WORTH RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334633213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619667707 | ||||||||
| FaxNumber: | 8883162198 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 218 | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619683806 | ||||||||
| FaxNumber: | 5619687673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2019 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | CASEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5619667702 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICAL SPECIALISTS OF THE PALM BEACHES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.