Provider Demographics
NPI:1831283399
Name:FAMILY PRACTICE ASSOCIATES OF MARTIN AND PALM BEACH COUNTIES PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF MARTIN AND PALM BEACH COUNTIES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-622-6111
Mailing Address - Street 1:1094 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7021
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:561-622-1176
Practice Address - Street 1:411 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-746-7826
Practice Address - Fax:561-744-7811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL GROUP OF SOUTH FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3205207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000S2OtherBCBS GROUP #
FLK2513Medicare PIN
FLK1549Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL45335OtherGROUP BCBS PRVIDER #
FL80092WMedicare ID - Type UnspecifiedDR. CUTLER MEDICARE #
FL82529OtherDR. SUROWITZ BCBS #
FL080114270OtherDR. SUROWTIZ RAILROAD MCR
FL80092OtherDR. CUTLER BCBS #
FLE3744ZMedicare ID - Type UnspecifiedK. HAGAN ARNP MEDICARE#