| Premium Medical Center Corp | |
|
6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 | |
| (786) 334-5047 | |
| (786) 334-5048 |
| Full Name | Premium Medical Center Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 6405 Nw 36th St Ste 111, Virginia Gardens, Florida |
| Authorized Official Name and Position | Deivys Gonzalez Oliva (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7863345047 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Medical Center Corp 6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 Ph: (786) 334-5047 | Premium Medical Center Corp 6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 Ph: (786) 334-5047 |
| NPI Number | 1053971937 |
|---|---|
| Provider Enumeration Date | 06/13/2019 |
| Last Update Date | 01/14/2025 |
| Certification Date | 01/14/2025 |
| Medicare PECOS PAC ID | 0244660520 |
|---|---|
| Medicare Enrollment ID | O20200429001542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053971937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Thomas A Gionis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780638049 PECOS PAC ID: 0547157687 Enrollment ID: I20200409001070 |
Court Options Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6555 Nw 36th St, Suite 328, Virginia Gardens, FL 33166 Phone: 305-378-8122 Fax: 305-870-9921 | |
Premium Medical Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6405 Nw 36th St Ste 11, Virginia Gardens, FL 33166 Phone: 786-334-5047 | |
Therapeutic Alliance Community Mental Health Center Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6405 Nw 36th St, Suite 100, Virginia Gardens, FL 33166 Phone: 305-871-3131 Fax: 305-871-2727 |