PALM BEACH PEDIATRIC UROLOGY NPI 1598739831

NPI Information

  • NPI: 1598739831
  • Provider Name: PALM BEACH PEDIATRIC UROLOGY
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • CLIA Number: 10D2090711
  • Address: 10301 HAGEN RANCH RD
    SUITE C130
    BOYNTON BEACH, FL
    ZIP 33437
  • Phone: (561) 736-7313

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NPI Details

PALM BEACH PEDIATRIC UROLOGY is an urology in Boynton Beach, FL. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. PALM BEACH PEDIATRIC UROLOGY NPI is 1598739831. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10301 HAGEN RANCH RD
SUITE C130
BOYNTON BEACH, FL
ZIP 33437
Phone: (561) 736-7313
Fax: (561) 736-2309

The provider's authorized official is Charles E Flack .
The authorized official title is President and has the following contact phone number (561) 512-0614.

The CLIA number assigned to this NPI record is 10D2090711 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2006 and was last updated on 10/22/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyME599337FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1103690OTHERFLORIDAAVMED
22032607OTHERFLORIDAAETNA HMO
3204200OTHERFLORIDAAMERIGROUP
45962OTHERFLORIDANHP
5272189900MEDICAIDFLORIDA
626943OTHERFLORIDAWELLCARE
74611456OTHERFLORIDAAETNA NON-HMO
812475OTHERFLORIDABCBS
91755943OTHERFLORIDACIGNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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