Provider Demographics
NPI:1760799613
Name:POLYCLINIQUE DE WESTPALM BEACH
Entity Type:Organization
Organization Name:POLYCLINIQUE DE WESTPALM BEACH
Other - Org Name:POLYCLINIQUE DE PALM BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGARO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:561-835-8385
Mailing Address - Street 1:734 BELVEDERE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405
Mailing Address - Country:US
Mailing Address - Phone:561-835-8385
Mailing Address - Fax:561-835-4077
Practice Address - Street 1:734 BELVEDERE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1108
Practice Address - Country:US
Practice Address - Phone:561-835-8385
Practice Address - Fax:561-835-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61479Medicare PIN