1083057442 NPI number — IM PRECISION MEDICAL GROUP PSC

Table of content: (NPI 1083057442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083057442 NPI number — IM PRECISION MEDICAL GROUP PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IM PRECISION MEDICAL GROUP PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083057442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13756
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00908-3756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 CALLE FLOR GERENA N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-4288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-518-0104
Provider Business Practice Location Address Fax Number:
939-307-8272
Provider Enumeration Date:
04/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JUARBE ARRILLAGA
Authorized Official First Name:
REBECA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-247-4463

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  18352 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com