Provider Demographics
NPI:1851475016
Name:PALM SPRINGS INTERNAL MEDICINE
Entity Type:Organization
Organization Name:PALM SPRINGS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-439-4480
Mailing Address - Street 1:5053 S CONGRESS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4706
Mailing Address - Country:US
Mailing Address - Phone:561-439-4480
Mailing Address - Fax:561-641-6626
Practice Address - Street 1:5053 S CONGRESS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4706
Practice Address - Country:US
Practice Address - Phone:561-439-4480
Practice Address - Fax:561-641-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061482300Medicaid
FL61548Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL061482300Medicaid