Provider Demographics
NPI:1376036145
Name:BEACH GASTRO LLC
Entity Type:Organization
Organization Name:BEACH GASTRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTREKUS PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-824-3447
Mailing Address - Street 1:4460 MEDICAL CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3285
Mailing Address - Country:US
Mailing Address - Phone:863-824-3447
Mailing Address - Fax:863-824-3472
Practice Address - Street 1:4460 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3285
Practice Address - Country:US
Practice Address - Phone:863-824-3447
Practice Address - Fax:863-824-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty