Provider Demographics
NPI:1629202775
Name:PREMIER MEDICAL CARE OF THE PALM BEACHES P A
Entity Type:Organization
Organization Name:PREMIER MEDICAL CARE OF THE PALM BEACHES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT JUPITER PROFESSIONAL DEV
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-2889
Mailing Address - Street 1:PO BOX 1937
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-1937
Mailing Address - Country:US
Mailing Address - Phone:561-748-2889
Mailing Address - Fax:561-748-1523
Practice Address - Street 1:3535 MILITARY TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5009
Practice Address - Country:US
Practice Address - Phone:561-745-0072
Practice Address - Fax:561-745-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty