MEDICARE: PALM BEACH OUTPATIENT SURGICAL CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	854	FL
2	261QA1903X	Ambulatory Surgical Clinic/Center
3	261QS0132X	Ophthalmologic Surgery Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00147666	OTHER		RR MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306843867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH OUTPATIENT SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2889 10TH AVE N STE 306
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3045
Country	:	US
Telephone Number	:	561-964-0707
Fax Number	:	561-467-4175

Provider Business Practice Location Address
First Line	:	2889 10TH AVE N STE 203
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3045
Country	:	US
Telephone Number	:	561-469-6208
Fax Number	:	561-725-8795

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MADONNA W COFFMAN
Credential	:
Telephone Number	:	561-576-8436

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/13/2025

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Practice Location Address:

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1932189438 — WILLIAM MARTIN MD
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1033176425 — DR. TOMMY MILLS COFFMAN MD
Practice Location Address:

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1699866301 — DR. DANIEL ELIE GOLDBERG M.D.
Practice Location Address:

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Directions to “PALM BEACH OUTPATIENT SURGICAL CENTER, LLC ” Practice Location

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