Healthcare Provider Details

I. General information

NPI: 1326010653
Provider Name (Legal Business Name): CMS WEST PALM BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 GREENWOOD AVE
WEST PALM BEACH FL
33407-2492
US

IV. Provider business mailing address

5101 GREENWOOD AVE
WEST PALM BEACH FL
33407-2492
US

V. Phone/Fax

Practice location:
  • Phone: 561-881-5040
  • Fax: 561-840-0102
Mailing address:
  • Phone: 561-881-5040
  • Fax: 561-881-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberN/AGOVERNMENT AGENCY
License Number StateFL

VIII. Authorized Official

Name: MS. PAULA M. MCADOW
Title or Position: PROGRAM MANAGER
Credential:
Phone: 561-881-5040