Healthcare Provider Details

I. General information

NPI: 1972327872
Provider Name (Legal Business Name): BOCA RATON REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 GLADES RD
BOCA RATON FL
33498-6739
US

IV. Provider business mailing address

PO BOX 71200
CHARLOTTE NC
28272-1200
US

V. Phone/Fax

Practice location:
  • Phone: 561-765-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LINCOLN SIDEL MENDEZ
Title or Position: CEO
Credential:
Phone: 561-955-4200