MEDICARE: CABBAGE PALM INPATIENT SERVICES 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1952068579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABBAGE PALM INPATIENT SERVICES LLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11300 110TH AVE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3711
Country	:	US
Telephone Number	:	727-391-9986
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	03/30/2023

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