Provider Demographics
NPI:1104375906
Name:PALM BEACH EMC
Entity Type:Organization
Organization Name:PALM BEACH EMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-704-4925
Mailing Address - Street 1:PO BOX 541541
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454
Mailing Address - Country:US
Mailing Address - Phone:561-704-4925
Mailing Address - Fax:561-509-6010
Practice Address - Street 1:4519 LAKE WORTH ROAD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-704-4925
Practice Address - Fax:561-509-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty