Provider Demographics
NPI:1629484886
Name:BOYNTON QUALITY MEDICAL CENTER
Entity Type:Organization
Organization Name:BOYNTON QUALITY MEDICAL CENTER
Other - Org Name:PAMELA A. MYERS M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-740-3299
Mailing Address - Street 1:11082 S MILITARY TRL # B46
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7217
Mailing Address - Country:US
Mailing Address - Phone:561-740-3299
Mailing Address - Fax:561-740-3749
Practice Address - Street 1:11082 S MILITARY TRL
Practice Address - Street 2:B46
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-740-3299
Practice Address - Fax:561-740-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72378OtherMEDICAL LICENSE
1104860105OtherNPI
G24359Medicare UPIN
1104860105OtherNPI