Provider Demographics
NPI:1245207976
Name:PROFESSIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNARELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-883-6789
Mailing Address - Street 1:461 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5346
Mailing Address - Country:US
Mailing Address - Phone:305-889-0303
Mailing Address - Fax:305-882-7020
Practice Address - Street 1:461 HIALEAH DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5346
Practice Address - Country:US
Practice Address - Phone:305-889-0303
Practice Address - Fax:305-882-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6690261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8914Medicare ID - Type UnspecifiedPART B