MEDICARE: ADVANCED PALM BEACH ASC LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1255182325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PALM BEACH ASC LLC

Provider Business Mailing Address
First Line	:	231 S BEMISTON AVE STE 850 PMB 82567
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8240 S STATE ROAD 7 STE 180
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-4516
Country	:	US
Telephone Number	:	727-692-8882
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHEREE LEPPINEN
Credential	:
Telephone Number	:	727-692-8882

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	04/27/2024

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