Provider Demographics
NPI:1033434485
Name:CENTRAL PALM BEACH SURGERY CENTER, L.T.D.
Entity Type:Organization
Organization Name:CENTRAL PALM BEACH SURGERY CENTER, L.T.D.
Other - Org Name:CENTRAL PALM BEACH SURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-721-6880
Mailing Address - Street 1:2047 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6522
Mailing Address - Country:US
Mailing Address - Phone:561-721-6880
Mailing Address - Fax:561-721-6885
Practice Address - Street 1:2047 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6522
Practice Address - Country:US
Practice Address - Phone:561-721-6880
Practice Address - Fax:561-721-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL924261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75736500Medicaid
FL75736500Medicaid