Provider Demographics
NPI:1528539558
Name:PEAK POTENTIAL INTEGRATIVE MEDICAL CENTER NPB, INC.
Entity type:Organization
Organization Name:PEAK POTENTIAL INTEGRATIVE MEDICAL CENTER NPB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-719-2220
Mailing Address - Street 1:11951 US HIGHWAY 1 STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2804
Mailing Address - Country:US
Mailing Address - Phone:866-719-2220
Mailing Address - Fax:
Practice Address - Street 1:11951 US HIGHWAY 1 STE 105
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2804
Practice Address - Country:US
Practice Address - Phone:866-719-2220
Practice Address - Fax:866-719-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417283706OtherSTATE OF FLORIDA