Provider Demographics
NPI:1770906406
Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE, INC.
Entity type:Organization
Organization Name:CENTRAL PALM BEACH PHYSICIANS & URGENT CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-967-8888
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9120
Mailing Address - Country:US
Mailing Address - Phone:561-966-7194
Mailing Address - Fax:561-966-7191
Practice Address - Street 1:2700 W CYPRESS CREEK RD
Practice Address - Street 2:SUITE C100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1744
Practice Address - Country:US
Practice Address - Phone:954-974-3111
Practice Address - Fax:954-974-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24454OtherFL BLUE GROUP #
FL24454OtherFL BLUE GROUP #