Healthcare Provider Details

I. General information

NPI: 1255006193
Provider Name (Legal Business Name): PBC FIREFIGHTERS EMPLOYEE BENEFITS FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 SW MARTIN DOWNS BLVD STE 33A
PALM CITY FL
34990-2679
US

IV. Provider business mailing address

7240 7TH PL N
WEST PALM BEACH FL
33411-3801
US

V. Phone/Fax

Practice location:
  • Phone: 561-969-6663
  • Fax: 561-721-3106
Mailing address:
  • Phone: 561-969-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEIGH CLARKE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 561-969-6663