Healthcare Provider Details

I. General information

NPI: 1679850523
Provider Name (Legal Business Name): PMC HILLSBORO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E HILLSBORO BLVD STE 210
DEERFIELD BEACH FL
33441-4348
US

IV. Provider business mailing address

1500 E HILLSBORO BLVD STE 210
DEERFIELD BEACH FL
33441-4348
US

V. Phone/Fax

Practice location:
  • Phone: 954-419-9632
  • Fax: 954-419-9634
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SPENCER ANGEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 954-419-9632