| Pmc Jackson South, Llc | |
|
9380 Sw 150th St Ste 100 Miami FL 33176-7979 | |
| (305) 253-2665 | |
| Not Available |
| Full Name | Pmc Jackson South, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9380 Sw 150th St Ste 100, Miami, Florida |
| Authorized Official Name and Position | Spencer Angel (MNG MBR) |
| Authorized Official Contact | 3058687180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmc Jackson South, Llc 12550 Biscayne Blvd Ste 500 North Miami FL 33181-2544 Ph: (305) 868-7180 | Pmc Jackson South, Llc 9380 Sw 150th St Ste 100 Miami FL 33176-7979 Ph: (305) 253-2665 |
| NPI Number | 1043469232 |
|---|---|
| Provider Enumeration Date | 09/12/2008 |
| Last Update Date | 09/12/2008 |
| Medicare PECOS PAC ID | 6901968478 |
|---|---|
| Medicare Enrollment ID | O20081217000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043469232 | NPI | - | NPPES |
| 207R00000X | Other | FL | TAXONOMY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Florida) | Primary |
| Provider Name | John T Mcadory |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104800283 PECOS PAC ID: 1951486026 Enrollment ID: I20080313000329 |
| Provider Name | Tashara Redding Jean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447599121 PECOS PAC ID: 4587892971 Enrollment ID: I20140109001684 |
| Provider Name | Lazara Medina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053916163 PECOS PAC ID: 2961892385 Enrollment ID: I20211129001848 |
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