Provider Demographics
NPI:1184214231
Name:PREMIUM MEDICAL CENTER GROUP LLC
Entity Type:Organization
Organization Name:PREMIUM MEDICAL CENTER GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MISS
Authorized Official - First Name:SILVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:786-572-9606
Mailing Address - Street 1:8300 W FLAGLER ST STE 254C-1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-6000
Mailing Address - Country:US
Mailing Address - Phone:786-572-9606
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 254C-1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6000
Practice Address - Country:US
Practice Address - Phone:786-572-9606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center