Provider Demographics
NPI:1598961930
Name:PMX PROVIDER SERVICES CORPORATION
Entity Type:Organization
Organization Name:PMX PROVIDER SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-463-8297
Mailing Address - Street 1:501 GAINSBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1213
Mailing Address - Country:US
Mailing Address - Phone:484-463-8297
Mailing Address - Fax:877-774-9729
Practice Address - Street 1:501 GAINSBORO ROAD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1213
Practice Address - Country:US
Practice Address - Phone:484-463-8297
Practice Address - Fax:877-774-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119397Medicare PIN