Provider Demographics
NPI:1235564303
Name:GRACE MEDICAL CENTER OF FLORIDA, INC.
Entity Type:Organization
Organization Name:GRACE MEDICAL CENTER OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WYSLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-841-6252
Mailing Address - Street 1:4212 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6252
Mailing Address - Country:US
Mailing Address - Phone:561-841-6252
Mailing Address - Fax:561-841-6260
Practice Address - Street 1:4212 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6252
Practice Address - Country:US
Practice Address - Phone:561-841-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty