Provider Demographics
NPI:1134687197
Name:LMT PREVENTIVE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:LMT PREVENTIVE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-201-7041
Mailing Address - Street 1:4545 PLEASANT HILL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3400
Mailing Address - Country:US
Mailing Address - Phone:407-201-7041
Mailing Address - Fax:407-201-8082
Practice Address - Street 1:4545 PLEASANT HILL RD STE 112
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3400
Practice Address - Country:US
Practice Address - Phone:407-201-7041
Practice Address - Fax:407-201-8082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LMT PREVENTIVE MEDICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care