MEDICARE: CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC

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	111N00000X	Chiropractor	CH5626	FL
2	207Q00000X	Family Medicine Physician	ME81066	FL

General Provider Information

NPI Number	:	1437416922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PALM BEACH PHYSICIANS & URGENT CARE INC

Provider Business Mailing Address
First Line	:	4623 FOREST HILL BLVD
Second Line	:	SUITE 101
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9120
Country	:	US
Telephone Number	:	561-967-8888
Fax Number	:	561-641-8303

Provider Business Practice Location Address
First Line	:	850 NW FEDERAL HWY
Second Line	:	SUITE 183
City	:	STUART
State	:	FL
Zip	:	34994-1019
Country	:	US
Telephone Number	:	772-467-2677
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUSS SEGER
Credential	:	D.C.
Telephone Number	:	561-967-8888

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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