MEDICARE: PCM MEDICAL CENTER 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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1851588396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PCM MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	731 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4553
Country	:	US
Telephone Number	:	305-863-2060
Fax Number	:	305-863-2027

Provider Business Practice Location Address
First Line	:	731 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4553
Country	:	US
Telephone Number	:	305-863-2060
Fax Number	:	305-863-2027

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSVALDO RICARDO
Credential	:
Telephone Number	:	305-863-2060

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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