Provider Demographics
NPI:1174167993
Name:PCC MEDICAL HOLDINGS LLC
Entity type:Organization
Organization Name:PCC MEDICAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:561-385-0731
Mailing Address - Street 1:1732 S CONGRESS AVE STE 346
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2140
Mailing Address - Country:US
Mailing Address - Phone:561-385-0731
Mailing Address - Fax:561-629-7302
Practice Address - Street 1:5055 SOUTH CONGRESS AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-385-0731
Practice Address - Fax:561-629-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization