NPIMap

Organization Active NPI

Boca Family Medical Group Corp

  • Family Medicine Physician
  • Boca Raton, FL
National Provider Identifier
1366730129
Registry record updated Jul 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOCA FAMILY MEDICAL GROUP CORP
Practice address
7280 W Palmetto Park Rd
Suite 104
Boca Raton, FL 33433-3422
Phone
(561) 391-6552
Fax
(561) 391-6285
NPI assigned
Jul 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2011

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

Authorized official

Name
Mirna Waidele, PA-C
Title
President
Phone
(561) 391-6552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

7280 W Palmetto Park Rd
Suite 104
Boca Raton, FL 33433-3422

Mailing address

7280 W Palmetto Park Rd
Suite 104
Boca Raton, FL 33433-3422
Phone (561) 391-6552

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310601600000",
    "number": "1366730129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7280 W PALMETTO PARK RD",
            "address_2": "SUITE 104",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333422",
            "telephone_number": "561-391-6552",
            "fax_number": "561-391-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7280 W PALMETTO PARK RD",
            "address_2": "SUITE 104",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333422",
            "telephone_number": "561-391-6552",
            "fax_number": "561-391-6285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOCA FAMILY MEDICAL GROUP CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-14",
        "last_updated": "2011-07-14",
        "status": "A",
        "authorized_official_last_name": "WAIDELE",
        "authorized_official_first_name": "MIRNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-391-6552",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; 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.