Provider Demographics
NPI:1497964407
Name:PALM BEACH OSTEOPATHIC CARE, INC.
Entity Type:Organization
Organization Name:PALM BEACH OSTEOPATHIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AM
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN'S WIFE
Authorized Official - Phone:561-324-9600
Mailing Address - Street 1:10887 N MILITARY TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6528
Mailing Address - Country:US
Mailing Address - Phone:561-324-9600
Mailing Address - Fax:561-799-9980
Practice Address - Street 1:10887 N MILITARY TRL STE 5
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6528
Practice Address - Country:US
Practice Address - Phone:561-324-9600
Practice Address - Fax:561-799-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9152204D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS9152OtherFLORIDA MEDICAL LICENSE
FL=========OtherFEDERAL EIN
FLK6281Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLI17071Medicare UPIN