Provider Demographics
NPI:1740262294
Name:PALM SERRA, INC.
Entity type:Organization
Organization Name:PALM SERRA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-7700
Mailing Address - Street 1:3105 S MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1022
Mailing Address - Country:US
Mailing Address - Phone:405-947-7700
Mailing Address - Fax:405-947-7300
Practice Address - Street 1:3690 E BAY DR
Practice Address - Street 2:UNIT T-U1
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5903
Practice Address - Country:US
Practice Address - Phone:727-726-7400
Practice Address - Fax:727-726-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991742251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107774Medicare ID - Type UnspecifiedPROVIDER NUMBER