Provider Demographics
NPI:1558716811
Name:PHYSICIAN ASSOCIATES OF THE PALM BEACHES
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:561-633-9913
Mailing Address - Street 1:49 SKYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6842
Mailing Address - Country:US
Mailing Address - Phone:561-633-9913
Mailing Address - Fax:561-403-1103
Practice Address - Street 1:49 SKYSTONE CT
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6842
Practice Address - Country:US
Practice Address - Phone:561-633-9913
Practice Address - Fax:561-403-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QG0300X
FLPA9101814363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1241XMedicare UPIN