Provider Demographics
NPI:1023021011
Name:PRIVATE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PRIVATE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-774-0742
Mailing Address - Street 1:10 NW 42ND AVE
Mailing Address - Street 2:SUITE#300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5473
Mailing Address - Country:US
Mailing Address - Phone:305-774-0742
Mailing Address - Fax:305-774-0836
Practice Address - Street 1:10 NW 42ND AVE
Practice Address - Street 2:SUITE#300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5473
Practice Address - Country:US
Practice Address - Phone:305-774-0742
Practice Address - Fax:305-774-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service