1295951267 NPI number — INTEGRATE COMMUNITY HEALTH SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295951267 NPI number — INTEGRATE COMMUNITY HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATE COMMUNITY HEALTH SYSTEM
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:
1295951267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CAMINO REAL STREET 19
Provider Second Line Business Mailing Address:
E 501
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-226-2206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
METROPOLITAN CLINIC
Provider Second Line Business Practice Location Address:
URBANIZACION LAS LOMAS CLINICAS EXT 1785 CARR 81
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-273-0950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NERY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
GOMEZ
Authorized Official Title or Position:
GENERAL PRACTITIONER
Authorized Official Telephone Number:
787-226-2206

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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