Provider Demographics
NPI:1770632457
Name:ABC MEDICAL SERVICE, LLC.
Entity Type:Organization
Organization Name:ABC MEDICAL SERVICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:GRAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-906-3333
Mailing Address - Street 1:1800 S.W. 1 ST.
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135
Mailing Address - Country:US
Mailing Address - Phone:305-906-3333
Mailing Address - Fax:305-914-5951
Practice Address - Street 1:1800 S.W. 1 ST.
Practice Address - Street 2:SUITE 318
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-906-3333
Practice Address - Fax:305-914-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81343261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty