NPIMap

Organization Active NPI

Palm Beach General Surgery LLC

  • Surgical Oncology Physician
  • Aventura, FL
National Provider Identifier
1073275897
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
Legal business name
PALM BEACH GENERAL SURGERY LLC
Practice address
21110 Biscayne Blvd Ste 400
Aventura, FL 33180-1252
Phone
(302) 285-5092
NPI assigned
Oct 8, 2021
Last updated
Oct 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PALM BEACH GENERAL SURGERY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Tedrick Johnson
Title
Vice President
Phone
(615) 372-3375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology Physician 2086X0206X NU Primary

Addresses

Primary practice location

21110 Biscayne Blvd Ste 400
Aventura, FL 33180-1252

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 372-5426

National Provider Directory

National Provider Directory
Tax ID family
Palm Beach General Surgery LLC7 organizations share this tax ID, including this one
Part of
Palm Beach General Surgery LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1073275897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-372-5426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21110 BISCAYNE BLVD STE 400",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331801252",
            "telephone_number": "302-285-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH GENERAL SURGERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALM BEACH GENERAL SURGERY LLC",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDRICK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aventura, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.