Provider Demographics
NPI:1083683411
Name:MEDICAL IPA OF THE PALM BEACHES
Entity type:Organization
Organization Name:MEDICAL IPA OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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:561-790-2876
Mailing Address - Street 1:1117 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1641
Mailing Address - Country:US
Mailing Address - Phone:561-790-2876
Mailing Address - Fax:561-790-3884
Practice Address - Street 1:1117 ROYAL PALM BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1641
Practice Address - Country:US
Practice Address - Phone:561-790-2876
Practice Address - Fax:561-790-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization