NPIMap

Organization Active NPI

Palm Beach General Surgery LLC

  • Gastroenterology Physician
  • West Palm Beach, FL
National Provider Identifier
1831869155
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PALM BEACH GENERAL SURGERY LLC
Practice address
4631 N Congress Ave Ste 110
West Palm Beach, FL 33407-3238
Phone
(561) 530-1725
NPI assigned
Sep 17, 2021
Organization subpart
Yes
Parent organization
PALM BEACH GENERAL SURGERY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 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
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

4631 N Congress Ave Ste 110
West Palm Beach, FL 33407-3238

Mailing address

2000 Health Park Dr # de
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": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1831869155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR # DE",
            "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": "4631 N CONGRESS AVE STE 110",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073238",
            "telephone_number": "561-530-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH GENERAL SURGERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALM BEACH GENERAL SURGERY LLC",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "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": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.