Provider Demographics
NPI:1013209980
Name:INTERMED SERVICES, PA
Entity Type:Organization
Organization Name:INTERMED SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-845-2081
Mailing Address - Street 1:PO BOX 10694
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33419-0694
Mailing Address - Country:US
Mailing Address - Phone:561-845-2081
Mailing Address - Fax:561-845-2953
Practice Address - Street 1:1115 45TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2376
Practice Address - Country:US
Practice Address - Phone:561-845-2081
Practice Address - Fax:561-845-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075961261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care