Healthcare Provider Details

I. General information

NPI: 1306843867
Provider Name (Legal Business Name): PALM BEACH OUTPATIENT SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 10TH AVE N STE 203
PALM SPRINGS FL
33461-3045
US

IV. Provider business mailing address

2889 10TH AVE N STE 306
PALM SPRINGS FL
33461-3045
US

V. Phone/Fax

Practice location:
  • Phone: 561-469-6208
  • Fax: 561-725-8795
Mailing address:
  • Phone: 561-964-0707
  • Fax: 561-467-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number854
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADONNA W COFFMAN
Title or Position: PRESIDENT
Credential:
Phone: 561-576-8436