Provider Demographics
NPI:1053595850
Name:COUNTRY DOCTOR MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:COUNTRY DOCTOR MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:561-743-2342
Mailing Address - Street 1:932 MARLIN CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4306
Mailing Address - Country:US
Mailing Address - Phone:561-743-2342
Mailing Address - Fax:866-896-2367
Practice Address - Street 1:11381 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3403
Practice Address - Country:US
Practice Address - Phone:561-743-2342
Practice Address - Fax:800-896-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTRY DOCTOR MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59301251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health