Healthcare Provider Details

I. General information

NPI: 1396178273
Provider Name (Legal Business Name): INTEGRATED MEDICAL CENTER OF PALM BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-6847
US

IV. Provider business mailing address

920 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-6847
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-7707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA BASSETT-IPPOLITO
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-747-7707