Provider Demographics
NPI:1770841959
Name:PHYSICIANS GROUP OF BOCA RATON
Entity Type:Organization
Organization Name:PHYSICIANS GROUP OF BOCA RATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-409-2224
Mailing Address - Street 1:7000 N. FEDERAL HWY.
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-409-2224
Mailing Address - Fax:561-756-9483
Practice Address - Street 1:7000 N FEDERAL HWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1644
Practice Address - Country:US
Practice Address - Phone:561-409-2224
Practice Address - Fax:561-756-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TP2701X, 111N00000X, 207R00000X
FL10D2044371291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty