Provider Demographics
NPI:1609117886
Name:PROCEDURAL MEDICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PROCEDURAL MEDICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-745-1313
Mailing Address - Street 1:11523 PALMBRUSH TRL
Mailing Address - Street 2:# 138
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2917
Mailing Address - Country:US
Mailing Address - Phone:941-745-1313
Mailing Address - Fax:941-745-1334
Practice Address - Street 1:11523 PALMBRUSH TRL
Practice Address - Street 2:# 138
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2917
Practice Address - Country:US
Practice Address - Phone:941-745-1313
Practice Address - Fax:941-745-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty