Provider Demographics
NPI:1720746951
Name:SOUTH PALM FAMILY CENTER
Entity Type:Organization
Organization Name:SOUTH PALM FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-348-0303
Mailing Address - Street 1:1701 SE HILLMOOR DR STE B9
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7540
Mailing Address - Country:US
Mailing Address - Phone:772-348-0303
Mailing Address - Fax:
Practice Address - Street 1:1701 SE HILLMOOR DR STE B9
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7540
Practice Address - Country:US
Practice Address - Phone:772-348-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty