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NPI Code Detail

MEDICARE: PRACTITIONER MEDICAL SERVICES INC

MEDICARE: PRACTITIONER MEDICAL SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/CenterP11000009589FL

General Provider Information

NPI Number : 1548545601
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRACTITIONER MEDICAL SERVICES INC
Provider Business Mailing Address
First Line : 22274 SW 61ST AVE
Second Line :
City : BOCA RATON
State : FL
Zip : 33428-4410
Country : US
Telephone Number : 561-843-2325
Fax Number : 561-483-6266
Provider Business Practice Location Address
First Line : 3075 NW 35TH AVE
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1107
Country : US
Telephone Number : 561-843-2325
Fax Number : 561-483-6266
Authorized Official
Title or Position : PRESIDENT
Name : MARIE MICHELLE CARNER
Credential : ARNP
Telephone Number : 561-843-2325
Provider Enumeration Date : 10/19/2011
Last Update Date : 09/06/2012

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Directions to “PRACTITIONER MEDICAL SERVICES INC ” Practice Location

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