PB Medical Group LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PB MEDICAL GROUP LLC

Practice address

2290 10TH Ave N Ste 201
Lake Worth, FL 33461-6609

Phone

(561) 225-2890

NPI assigned

Sep 25, 2015

Organization subpart

No

Name

Colin Davis Wallace, MBR

Title

Co-Founder and Ceo

Phone

(561) 255-4135

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2015.

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1366812943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 10TH AVE N STE 201",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334616609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 10TH AVE N STE 201",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334616609",
            "telephone_number": "561-225-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PB MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-25",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "COLIN",
        "authorized_official_middle_name": "DAVIS",
        "authorized_official_title_or_position": "CO-FOUNDER AND CEO",
        "authorized_official_telephone_number": "561-255-4135",
        "authorized_official_credential": "MBR"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breana Paul
• Kari Paul
• Duckens Paulin
• Pax Campus, LLC
• PB Laboratories LLC
• PB Medical LLC
• PBND Care Inc
• PBS
• PCC Medical Holdings LLC
• PCP Specialists of the Palm Beaches, LLC

• All providers in Lake Worth, FL
• Addiction (Substance Use Disorder) Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; 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.