Provider Demographics
NPI:1619577798
Name:PEDIATRIC PARTNERS OF PALM BEACH COUNTY
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF PALM BEACH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-510-2356
Mailing Address - Street 1:3401 PGA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 PGA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2824
Practice Address - Country:US
Practice Address - Phone:561-741-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108433100Medicaid