Provider Demographics
NPI:1609469402
Name:PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC
Entity Type:Organization
Organization Name:PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-859-4275
Mailing Address - Street 1:5458 TOWN CENTER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1026
Mailing Address - Country:US
Mailing Address - Phone:561-859-4275
Mailing Address - Fax:
Practice Address - Street 1:7710 NW 71ST CT STE 205
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2931
Practice Address - Country:US
Practice Address - Phone:954-747-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty