Provider Demographics
NPI:1366082620
Name:MOBILE MEDICAL CARE OF THE PALM BEACHES PA
Entity type:Organization
Organization Name:MOBILE MEDICAL CARE OF THE PALM BEACHES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O. OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-410-0242
Mailing Address - Street 1:1600 S FEDERAL HWY STE 420
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7531
Mailing Address - Country:US
Mailing Address - Phone:561-410-0242
Mailing Address - Fax:
Practice Address - Street 1:1600 S FEDERAL HWY STE 420
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7531
Practice Address - Country:US
Practice Address - Phone:561-410-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty