Provider Demographics
NPI:1891499901
Name:PROFESSIONAL MEDICAL CARE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SURANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-797-9377
Mailing Address - Street 1:20237 BACK NINE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4712
Mailing Address - Country:US
Mailing Address - Phone:561-797-9377
Mailing Address - Fax:
Practice Address - Street 1:20237 BACK NINE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4712
Practice Address - Country:US
Practice Address - Phone:561-797-9377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty