Provider Demographics
NPI:1922279389
Name:PALM BEACH OBSTETRICS & GYNECOLOGY, PA
Entity Type:Organization
Organization Name:PALM BEACH OBSTETRICS & GYNECOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VITERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-434-0111
Mailing Address - Street 1:4671 S CONGRESS AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4783
Mailing Address - Country:US
Mailing Address - Phone:561-434-0111
Mailing Address - Fax:561-296-3533
Practice Address - Street 1:4671 S CONGRESS AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4783
Practice Address - Country:US
Practice Address - Phone:561-434-0111
Practice Address - Fax:561-296-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256189100Medicaid
FL371772100Medicaid
FL272505300Medicaid
FL004197300Medicaid
FL002004200Medicaid
FL272506100Medicaid
FL002004200Medicaid