Basic Information
| Provider Information | |||||||||
| NPI: | 1982166492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUPITER WEST MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2632 W INDIANTOWN RD | ||||||||
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| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334585889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612363741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7556 LAKE WORTH RD STE 102 | ||||||||
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| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334672503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618550099 | ||||||||
| FaxNumber: | 8007835176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | OSWALD | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5612363741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.