Provider Demographics
NPI:1639593338
Name:PALM BEACH THYROID AND ENDOCRINOLOGY WELLNESS, LLC
Entity Type:Organization
Organization Name:PALM BEACH THYROID AND ENDOCRINOLOGY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:561-303-2800
Mailing Address - Street 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4932
Mailing Address - Country:US
Mailing Address - Phone:561-303-2800
Mailing Address - Fax:561-303-2801
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-303-2800
Practice Address - Fax:561-303-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-16
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104955261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCE597ZMedicare Oscar/Certification