Basic Information
| Provider Information | |||||||||
| NPI: | 1386136570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURAMED HEALTH CENTER PA | ||||||||
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| OtherOrganizationName: | SURAMED HEALTH CENTER PA GREENACRES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6293 LAKE WORTH RD | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618121271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3255 FOREST HILL BLVD STE 107 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334065854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612757100 | ||||||||
| FaxNumber: | 5612757199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARANGO | ||||||||
| AuthorizedOfficialFirstName: | SERGIO | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5612757100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOMA MEDICAL CENTER PA #3 | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.