Provider Demographics
NPI:1083297071
Name:LQV WEST PALM BEACH
Entity Type:Organization
Organization Name:LQV WEST PALM BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-650-2130
Mailing Address - Street 1:1460 HIPPOCRATES WAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEST PALM
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1460 HIPPOCRATES WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST PALM
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-463-8227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center