Provider Demographics
NPI:1316135338
Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE, INC.
Entity type:Organization
Organization Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:SEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-967-8888
Mailing Address - Street 1:6110 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2320
Mailing Address - Country:US
Mailing Address - Phone:561-649-8686
Mailing Address - Fax:561-721-9029
Practice Address - Street 1:6110 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2320
Practice Address - Country:US
Practice Address - Phone:561-649-8686
Practice Address - Fax:561-721-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24454OtherMEDICARE GROUP NUMBER