MEDICARE: OLYMPIA MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104800556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPIA MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	3933 N HAVERHILL RD STE 115
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8338
Country	:	US
Telephone Number	:	561-478-7659
Fax Number	:	877-317-6158

Provider Business Practice Location Address
First Line	:	3933 HAVERHILL RD N
Second Line	:	SUITE 115
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-7424
Country	:	US
Telephone Number	:	561-478-7659
Fax Number	:	561-478-7957

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RENES CASTOR
Credential	:	MD
Telephone Number	:	561-478-7659

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/22/2019

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