Healthcare Provider Details

I. General information

NPI: 1174167993
Provider Name (Legal Business Name): PCC MEDICAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 SOUTH CONGRESS AVENUE SUITE 303
LAKE WORTH FL
33461
US

IV. Provider business mailing address

1732 S CONGRESS AVE STE 346
PALM SPRINGS FL
33461-2140
US

V. Phone/Fax

Practice location:
  • Phone: 561-385-0731
  • Fax: 561-629-7302
Mailing address:
  • Phone: 561-385-0731
  • Fax: 561-629-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM STEELE
Title or Position: CEO
Credential: CEO
Phone: 561-385-0731