Provider Demographics
NPI:1841298437
Name:WEST PALM OUTPATIENT SURGERY AND LASER CENTER LTD
Entity type:Organization
Organization Name:WEST PALM OUTPATIENT SURGERY AND LASER CENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:200 NORTHPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1967
Mailing Address - Country:US
Mailing Address - Phone:561-615-0110
Mailing Address - Fax:561-615-8009
Practice Address - Street 1:200 NORTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1967
Practice Address - Country:US
Practice Address - Phone:561-615-0110
Practice Address - Fax:561-615-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1035261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490003237OtherRAILROAD MEDICARE
FL079220900Medicaid
FL66FOtherBLUE CROSS PROVIDER NUMBE
FL079220900Medicaid