Provider Demographics
NPI:1497415053
Name:JUPITER WEST MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:JUPITER WEST MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-236-3741
Mailing Address - Street 1:2632 W INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5889
Mailing Address - Country:US
Mailing Address - Phone:561-744-7373
Mailing Address - Fax:800-783-5176
Practice Address - Street 1:10377 S US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5630
Practice Address - Country:US
Practice Address - Phone:772-337-1300
Practice Address - Fax:800-783-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000647406Medicaid