Provider Demographics
NPI:1518130020
Name:PROFESSIONAL-MED CARE SERVICES CORP
Entity Type:Organization
Organization Name:PROFESSIONAL-MED CARE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-598-8486
Mailing Address - Street 1:10691 SW 88TH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8712
Mailing Address - Country:US
Mailing Address - Phone:305-598-8486
Mailing Address - Fax:305-598-8487
Practice Address - Street 1:10691 SW 88TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8712
Practice Address - Country:US
Practice Address - Phone:305-598-8486
Practice Address - Fax:305-598-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109427OtherMEDICARE PTAN