Provider Demographics
NPI:1548750193
Name:PRIMARY CARE PHYSICIANS OF WEST PALM BEACH, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF WEST PALM BEACH, LLC
Other - Org Name:PRIMARY CARE PHYSICIANS OF WEST PALM BEACH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-563-4472
Mailing Address - Street 1:2488 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3624
Mailing Address - Country:US
Mailing Address - Phone:954-983-9191
Mailing Address - Fax:954-983-1152
Practice Address - Street 1:100 CENTURY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-2262
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:954-983-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty