Provider Demographics
NPI:1780192112
Name:PMC KNEE PAIN & RESTORATION LLC
Entity Type:Organization
Organization Name:PMC KNEE PAIN & RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-482-3348
Mailing Address - Street 1:200 SW 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0952
Mailing Address - Country:US
Mailing Address - Phone:352-369-0104
Mailing Address - Fax:352-369-0107
Practice Address - Street 1:200 SW 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-369-0104
Practice Address - Fax:352-369-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty