Provider Demographics
NPI:1982768941
Name:PALM BEACH ORTHOPAEDIC ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:PALM BEACH ORTHOPAEDIC ASSOCIATES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-627-2821
Mailing Address - Street 1:2580 METROCENTRE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3100
Mailing Address - Country:US
Mailing Address - Phone:561-684-2022
Mailing Address - Fax:561-478-7921
Practice Address - Street 1:2580 METROCENTRE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3100
Practice Address - Country:US
Practice Address - Phone:561-684-2022
Practice Address - Fax:561-478-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X, 207T00000X, 207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0371181-00Medicaid
FL0011ROtherBLUE CROSS
FL0011ROtherBLUE CROSS