Provider Demographics
NPI:1871851048
Name:PHYSICIANS CARE PLUS OF WEST PALM BEACH, LLC
Entity Type:Organization
Organization Name:PHYSICIANS CARE PLUS OF WEST PALM BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-318-6590
Mailing Address - Street 1:5405 OKEECHOBEE BLVD
Mailing Address - Street 2:303
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4543
Mailing Address - Country:US
Mailing Address - Phone:561-689-8686
Mailing Address - Fax:561-689-8682
Practice Address - Street 1:5405 OKEECHOBEE BLVD
Practice Address - Street 2:303
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4543
Practice Address - Country:US
Practice Address - Phone:561-689-8686
Practice Address - Fax:561-689-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization