Provider Demographics
NPI:1497473789
Name:LW MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LW MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-704-6781
Mailing Address - Street 1:7601 N FEDERAL HWY STE 245A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1672
Mailing Address - Country:US
Mailing Address - Phone:561-704-6781
Mailing Address - Fax:561-209-0868
Practice Address - Street 1:19 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3727
Practice Address - Country:US
Practice Address - Phone:561-704-6781
Practice Address - Fax:561-209-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty