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General NPI Number Information
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NPI Number | 1376342568
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Entity Type | Organization
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Legal Business Name | LMJ SERVICES CENTER CORP
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 207 SW 15TH PL
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City | HOMESTEAD
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State | FL
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Zip | 33030-6661
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Country | US
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Telephone | 305-540-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SW 15TH PL
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City | HOMESTEAD
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State | FL
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Zip | 33030-6661
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Country | US
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Telephone | 305-540-3261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEITH RANDALL GOULD
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Credential | D.O
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Telephone | 305-540-3261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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