MEDICARE: CYBERKNIFE CENTER OF PALM BEACH 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	261QX0203X	Radiation Oncology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95788C	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1528076148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYBERKNIFE CENTER OF PALM BEACH LLC

Provider Business Mailing Address
First Line	:	10335 N MILITARY TRL
Second Line	:	SUITE C
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-4634
Country	:	US
Telephone Number	:	561-799-2828
Fax Number	:	561-775-3788

Provider Business Practice Location Address
First Line	:	10335 N MILITARY TRL
Second Line	:	SUITE C
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-4634
Country	:	US
Telephone Number	:	561-799-2828
Fax Number	:	561-775-3788

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. JAMES G. SCHWADE
Credential	:	MD
Telephone Number	:	305-670-2256

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/05/2009

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