Healthcare Provider Details

I. General information

NPI: 1780041467
Provider Name (Legal Business Name): SURGICAL FIRST ASSIST OF THE PALM BEACHES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 SW 17TH AVE
BOYNTON BEACH FL
33426-6443
US

IV. Provider business mailing address

PO BOX 970528
COCONUT CREEK FL
33097-0528
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-8224
  • Fax: 954-227-7442
Mailing address:
  • Phone: 954-227-8227
  • Fax: 954-227-7442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1473382
License Number StateFL

VIII. Authorized Official

Name: ERIC ACCO
Title or Position: BILLING MNGR
Credential:
Phone: 954-227-8224