Provider Demographics
NPI: | 1003368598 |
---|---|
Name: | ROYAL PALM BEACH REHAB, CORP. |
Entity Type: | Organization |
Organization Name: | ROYAL PALM BEACH REHAB, CORP. |
Other - Org Name: | FLORIDA ORTHOCARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PAPA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 561-801-2535 |
Mailing Address - Street 1: | 3345 BURNS RD |
Mailing Address - Street 2: | SUITE 202 |
Mailing Address - City: | PALM BEACH GARDENS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33410-4324 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-588-9912 |
Mailing Address - Fax: | 561-828-2908 |
Practice Address - Street 1: | 7541 W OAKLAND PARK BLVD |
Practice Address - Street 2: | |
Practice Address - City: | TAMARAC |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33319-4909 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-588-9912 |
Practice Address - Fax: | 561-828-2908 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-31 |
Last Update Date: | 2017-09-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | DE903A | Medicare PIN |