Provider Demographics
NPI:1225591084
Name:PCP SPECIALISTS OF THE PALM BEACHES, LLC
Entity Type:Organization
Organization Name:PCP SPECIALISTS OF THE PALM BEACHES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-966-7702
Mailing Address - Street 1:5700 LAKE WORTH RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3213
Mailing Address - Country:US
Mailing Address - Phone:561-966-7707
Mailing Address - Fax:888-316-2198
Practice Address - Street 1:5401 S CONGRESS AVE STE 218
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-6337
Practice Address - Country:US
Practice Address - Phone:561-968-3806
Practice Address - Fax:561-968-7673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SPECIALISTS OF THE PALM BEACHES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty