Provider Demographics
NPI:1770543431
Name:ROYAL PALM MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:ROYAL PALM MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERLINCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-745-3877
Mailing Address - Street 1:1410 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1641
Mailing Address - Country:US
Mailing Address - Phone:561-790-0789
Mailing Address - Fax:561-790-3884
Practice Address - Street 1:1410 ROYAL PALM BEACH BLVD
Practice Address - Street 2:STE. A
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1641
Practice Address - Country:US
Practice Address - Phone:561-790-0789
Practice Address - Fax:561-790-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36052OtherAOA
FL376148700Medicaid
FL376148700Medicaid
FLE07296Medicare UPIN