MEDICARE: PRIME CARE OF PALM BEACH P.L.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0071449	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB6052	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114118528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE OF PALM BEACH P.L.

Provider Business Mailing Address
First Line	:	PO BOX 5839
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33466-5839
Country	:	US
Telephone Number	:	561-296-2273
Fax Number	:	561-296-0495

Provider Business Practice Location Address
First Line	:	3199 LAKE WORTH RD
Second Line	:	SUITE B4
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3652
Country	:	US
Telephone Number	:	561-296-2273
Fax Number	:	561-296-0495

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FELIX S ELPEDES JR.
Credential	:	MD
Telephone Number	:	561-296-2273

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	11/11/2010

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