Healthcare Provider Details

I. General information

NPI: 1225756042
Provider Name (Legal Business Name): PRM OF VIRGINIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 05/25/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 PALM BEACH LAKES BLVD STE 700
WEST PALM BEACH FL
33409-6508
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 700
WEST PALM BEACH FL
33409-6508
US

V. Phone/Fax

Practice location:
  • Phone: 561-805-3873
  • Fax: 561-318-0134
Mailing address:
  • Phone: 561-805-3873
  • Fax: 561-318-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANE M LAGNESE
Title or Position: DIRECTOR RCM
Credential:
Phone: 561-422-4206