Organization
IPS OF PALM COAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R. NOBACK MD (MEDICAL DIRECTOR)
(941) 360-1566
Entity
Organization
Contact information
Practice address
21 HOSPITAL DR, STE 220, PALM COAST, FL 32164-2452
(386) 263-6020
Mailing address
PO BOX 864483, ORLANDO, FL 32886-4483
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/06/2009
Last updated
04/06/2009
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