Provider Demographics
NPI:1124596051
Name:PALMETTO MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PALMETTO MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-888-0444
Mailing Address - Street 1:7392 NW 35TH TER STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1271
Mailing Address - Country:US
Mailing Address - Phone:305-888-0444
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-888-0444
Practice Address - Fax:305-888-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center