NPIMap

Organization Active NPI

Palm Medical Center Lakeland LLC

Doing business as Palm Medical Centers

  • Clinic/Center
  • Avon Park, FL
National Provider Identifier
1417642711
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PALM MEDICAL CENTER LAKELAND LLC
Doing business as
Palm Medical Centers
Practice address
1221 W Stratford Rd
Avon Park, FL 33825-8091
Phone
(863) 453-2500
Fax
(863) 453-0745
NPI assigned
Apr 11, 2023
Last updated
Apr 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Authorized official

Name
Santiago Moises Martin
Title
President, Center Operations
Phone
(305) 913-9441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1221 W Stratford Rd
Avon Park, FL 33825-8091

Mailing address

2600 S Douglas Rd Ste 308
Coral Gables, FL 33134-6134
Phone (813) 538-7880

Other names 1

  • Palm Medical Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Palm Medical Center Lakeland LLC36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1417642711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S DOUGLAS RD STE 308",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331346134",
            "telephone_number": "813-538-7880",
            "fax_number": "813-538-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 W STRATFORD RD",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338258091",
            "telephone_number": "863-453-2500",
            "fax_number": "863-453-0745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM MEDICAL CENTER LAKELAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "MOISES MARTIN",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "PRESIDENT, CENTER OPERATIONS",
        "authorized_official_telephone_number": "305-913-9441"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avon Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.