Provider Demographics
NPI:1255635454
Name:PMC NORTH SHORE, LLC
Entity type:Organization
Organization Name:PMC NORTH SHORE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-255-1355
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2063
Mailing Address - Country:US
Mailing Address - Phone:305-835-9844
Mailing Address - Fax:305-835-9851
Practice Address - Street 1:1190 NW 95 STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150
Practice Address - Country:US
Practice Address - Phone:305-835-9844
Practice Address - Fax:305-835-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service