Provider Demographics
NPI:1598124851
Name:DELRAY BEACH OUTPATIENT SERVICES, LLC
Entity Type:Organization
Organization Name:DELRAY BEACH OUTPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-413-9860
Mailing Address - Street 1:2512 N FEDERAL HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6147
Mailing Address - Country:US
Mailing Address - Phone:561-303-2291
Mailing Address - Fax:
Practice Address - Street 1:2512 N FEDERAL HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6147
Practice Address - Country:US
Practice Address - Phone:561-303-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty