Provider Demographics
NPI:1104183672
Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC
Entity Type:Organization
Organization Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC
Other - Org Name:MCPB ORTHOPEDICS & NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-967-8888
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415
Mailing Address - Country:US
Mailing Address - Phone:561-967-8888
Mailing Address - Fax:561-641-8303
Practice Address - Street 1:12811 KENWOOD LN
Practice Address - Street 2:SUITE 118
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5667
Practice Address - Country:US
Practice Address - Phone:772-467-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5626111N00000X
FLME81066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty