Healthcare Provider Details

I. General information

NPI: 1780192112
Provider Name (Legal Business Name): PMC KNEE PAIN & RESTORATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 8TH ST STE A
OCALA FL
34471
US

IV. Provider business mailing address

200 SW 8TH ST STE A
OCALA FL
34471-0952
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0104
  • Fax: 352-369-0107
Mailing address:
  • Phone: 352-369-0104
  • Fax: 352-369-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY L MORERA
Title or Position: CEO
Credential:
Phone: 813-482-3348