Provider Demographics
NPI:1043463300
Name:JUPITER WEST MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:JUPITER WEST MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-624-2706
Mailing Address - Street 1:2632 W INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5889
Mailing Address - Country:US
Mailing Address - Phone:561-624-2706
Mailing Address - Fax:561-630-3948
Practice Address - Street 1:7171 N UNIVERSITY DR
Practice Address - Street 2:100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:561-624-2706
Practice Address - Fax:561-630-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34540AMedicare PIN