Provider Demographics
NPI:1508901570
Name:PALM BEACH SPORTSMEDICINE & ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:PALM BEACH SPORTSMEDICINE & ORTHOPAEDIC CENTER PA
Other - Org Name:PALM BEACH SPORTSMEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-845-6000
Mailing Address - Street 1:4440 BEACON CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3243
Mailing Address - Country:US
Mailing Address - Phone:561-845-6000
Mailing Address - Fax:561-845-6916
Practice Address - Street 1:4440 BEACON CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3243
Practice Address - Country:US
Practice Address - Phone:561-845-6000
Practice Address - Fax:561-845-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029407207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0913640001Medicare NSC