Provider Demographics
NPI:1558597625
Name:ACCIDENT AND WELLNESS CLINICS
Entity Type:Organization
Organization Name:ACCIDENT AND WELLNESS CLINICS
Other - Org Name:GRAND MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MM
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC BS
Authorized Official - Phone:786-370-1111
Mailing Address - Street 1:PO BOX 6455
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-429-5840
Mailing Address - Fax:561-429-5804
Practice Address - Street 1:4212 NORTH LAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-627-2821
Practice Address - Fax:651-627-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9389111N00000X
FLME98091207X00000X
FLME62002208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty