Healthcare Provider Details

I. General information

NPI: 1184957896
Provider Name (Legal Business Name): POCKET MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2009
Last Update Date: 09/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12491 SW 134TH CT STE 22
MIAMI FL
33186-6416
US

IV. Provider business mailing address

12491 SW 134TH CT STE 22
MIAMI FL
33186-6416
US

V. Phone/Fax

Practice location:
  • Phone: 352-667-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: HENRY WHITE
Title or Position: MANAGER
Credential:
Phone: 352-667-1234