MEDICARE: PROFESSIONAL MEDICAL SRVCS CORP

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1881733483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL MEDICAL SRVCS CORP

Provider Business Mailing Address
First Line	:	315 W 9TH ST FL 2
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3853
Country	:	US
Telephone Number	:	305-888-6464
Fax Number	:	305-888-9696

Provider Business Practice Location Address
First Line	:	315 W 9TH ST FL 2
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3853
Country	:	US
Telephone Number	:	305-888-6464
Fax Number	:	305-888-9696

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LIZETTE SANTOS
Credential	:
Telephone Number	:	305-888-6464

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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