Provider Demographics
NPI:1114118528
Name:PRIME CARE OF PALM BEACH P.L.
Entity Type:Organization
Organization Name:PRIME CARE OF PALM BEACH P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELPEDES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-296-2273
Mailing Address - Street 1:PO BOX 5839
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33466-5839
Mailing Address - Country:US
Mailing Address - Phone:561-296-2273
Mailing Address - Fax:561-296-0495
Practice Address - Street 1:3199 LAKE WORTH RD
Practice Address - Street 2:SUITE B4
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3652
Practice Address - Country:US
Practice Address - Phone:561-296-2273
Practice Address - Fax:561-296-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB6052OtherRAILROAD MEDICARE
FL250963600Medicaid
FLDB6052OtherRAILROAD MEDICARE