Provider Demographics
NPI:1588697296
Name:WEST BOCA MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WEST BOCA MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:461-488-8140
Mailing Address - Street 1:PO BOX 741249
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1249
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:561-488-8105
Practice Address - Street 1:21644 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1842
Practice Address - Country:US
Practice Address - Phone:561-488-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
100268B000000OtherSECTION 1011
758584410OtherAETNA US HEALTHCARE
291OtherBCBS OF FLORIDA
187244OtherCOVENTRY HEALTH CARE
WBOCA1000OtherNEIGHBORHOOD HEALTH PLAN
FL012024300Medicaid
63583(HMO)OtherAETNA US HEALTHCARE
6201580(NON-HMO)OtherAETNA US HEALTHCARE
070030OtherAVMED
080086OtherHUMANA
990366OtherNEIGHBORHOOD HEALTH PLAN
63583(HMO)OtherAETNA US HEALTHCARE