Provider Demographics
NPI:1407249881
Name:PALM BEACH MEDICAL PRACTITIONERS LLC
Entity Type:Organization
Organization Name:PALM BEACH MEDICAL PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANDIMISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:POSADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-329-5019
Mailing Address - Street 1:416 CLEMATIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5312
Mailing Address - Country:US
Mailing Address - Phone:561-329-5019
Mailing Address - Fax:
Practice Address - Street 1:1501 PRESIDENTIAL WAY STE 20
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1852
Practice Address - Country:US
Practice Address - Phone:561-616-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2021-04-26
Deactivation Date:2017-03-14
Deactivation Code:
Reactivation Date:2017-03-30
Provider Licenses
StateLicense IDTaxonomies
171W00000X
FLARNP9256208305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty