Organization
PMC JACKSON SOUTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SPENCER ANGEL (MNG MBR)
(305) 868-7180
Entity
Organization
Contact information
Practice address
9380 SW 150TH ST STE 100, MIAMI, FL 33176-7979
(305) 253-2665
Mailing address
12550 BISCAYNE BLVD STE 500, NORTH MIAMI, FL 33181-2544
(305) 868-7180
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207R00000X
TAXONOMY
FL
Enumeration date
09/12/2008
Last updated
09/12/2008
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