=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831577659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 E HALLANDALE BEACH BLVD
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-967-8888
-----------------------------------------------------
Fax | 561-967-4290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4623 FOREST HILL BLVD SUITE 101
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33415-7469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-967-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RUSS SEGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-967-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------