Basic Information
| Provider Information | |||||||||
| NPI: | 1326078288 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DELRAY MEDICAL CENTER, INC. | ||||||||
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| OtherOrganizationName: | DELRAY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741211 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619822189 | ||||||||
| FaxNumber: | 5619822509 | ||||||||
| Practice Location | |||||||||
| Address1: | 5352 LINTON BLVD | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614984440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARTWRIGHT | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5614953100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4439 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 080085 | 01 | HUMANA | OTHER | 990079 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 259929070 | 01 | AETNA US HEALTHCARE (NATI | OTHER | 104065 | 01 | AVMED | OTHER | 233136 | 01 | COVENTRY HEALTH CARE KANS | OTHER | 4097106 | 05 | NJ | MEDICAID | 100258B000000 | 01 | SECTION 1011 | OTHER | 290 | 01 | BCBS OF FLORIDA | OTHER | 012009000 | 05 | FL | MEDICAID |