Provider Demographics
NPI: | 1821439373 |
---|---|
Name: | PALM BEACH RESEARCH CENTER |
Entity Type: | Organization |
Organization Name: | PALM BEACH RESEARCH CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PREZIDENT AND CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | N/A |
Authorized Official - Last Name: | SCOTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 561-689-0606 |
Mailing Address - Street 1: | 2277 PALM BEACH LAKES BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST PALM BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33409-3401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-689-0606 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2277 PALM BEACH LAKES BLVD |
Practice Address - Street 2: | |
Practice Address - City: | WEST PALM BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33409-3401 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-689-0606 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-07-12 |
Last Update Date: | 2013-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME81958 | 261QR1100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1100X | Ambulatory Health Care Facilities | Clinic/Center | Research |