Provider Demographics
NPI:1912151739
Name:BOYNTON BEACH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BOYNTON BEACH MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALLERIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-752-2323
Mailing Address - Street 1:706 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3649
Mailing Address - Country:US
Mailing Address - Phone:561-752-2323
Mailing Address - Fax:561-752-2324
Practice Address - Street 1:706 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3649
Practice Address - Country:US
Practice Address - Phone:561-752-2323
Practice Address - Fax:561-752-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAZ128Medicare PIN