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General NPI Number Information
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NPI Number | 1932413531
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Entity Type | Organization
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Legal Business Name | PYRIMED HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 2100 W 76TH ST SUITE 313A
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City | HIALEAH
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State | FL
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Zip | 33016-5539
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Country | US
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Telephone | 954-399-5887
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 N FLAMINGO RD SUITE 158
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RUDOLPH JOHNSON
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Credential |
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Telephone | 954-399-5887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 234273
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License Number State | FL
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