Provider Demographics
NPI:1780670901
Name:PCM MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PCM MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-2060
Mailing Address - Street 1:731 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4553
Mailing Address - Country:US
Mailing Address - Phone:305-863-2060
Mailing Address - Fax:305-863-2027
Practice Address - Street 1:731 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4553
Practice Address - Country:US
Practice Address - Phone:305-863-2060
Practice Address - Fax:305-863-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3708261Q00000X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684837Medicare PIN