Healthcare Provider Details

I. General information

NPI: 1356625701
Provider Name (Legal Business Name): PBCGME/PALMS WEST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD DEPT OF GRADUATE MEDICAL EDUCATION
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

13001 SOUTHERN BLVD DEPT OF GRADUATE MEDICAL EDUCATION
LOXAHATCHEE FL
33470-9203
US

V. Phone/Fax

Practice location:
  • Phone: 561-784-3127
  • Fax:
Mailing address:
  • Phone: 561-784-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberUO2848
License Number StateFL

VIII. Authorized Official

Name: RANDI SPERLING
Title or Position: DIRECTOR OF MEDICAL EDUCATION
Credential: D.O.
Phone: 561-784-3127