MEDICARE: PROMED HEALTHCARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1760240709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	2112 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-7670
Country	:	US
Telephone Number	:	561-755-7515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 S CONGRESS AVE STE 101
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-7670
Country	:	US
Telephone Number	:	561-755-7515
Fax Number	:	352-632-5514

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JEAN DEJEAN
Credential	:
Telephone Number	:	561-755-7515

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	04/12/2024

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