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General NPI Number Information
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NPI Number | 1780192112
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Entity Type | Organization
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Legal Business Name | PMC KNEE PAIN & RESTORATION LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 200 SW 8TH ST STE A
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City | OCALA
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State | FL
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Zip | 34471
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Country | US
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Telephone | 352-369-0104
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Fax | 352-369-0107
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Provider Business Mailing Address
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Address Line | 200 SW 8TH ST STE A
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City | OCALA
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State | FL
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Zip | 34471-0952
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Country | US
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Telephone | 352-369-0104
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Fax | 352-369-0107
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Authorized Official
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Title or Position | CEO
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Name | ASHLEY L MORERA
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Credential |
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Telephone | 813-482-3348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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