1780632638 NPI number — INTERMED PRIMARY CARE

Table of content: (NPI 1780632638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780632638 NPI number — INTERMED PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERMED PRIMARY CARE
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:
1780632638
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:
PO BOX 7589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-7589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-5353
Provider Business Mailing Address Fax Number:
787-653-5364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. LUIS MUNOZ MARIN ESQ. GEORGETTI
Provider Second Line Business Practice Location Address:
EDIF. ANGORA PARK 2DO NIVEL
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-5353
Provider Business Practice Location Address Fax Number:
787-653-5364
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTORA DE FACTURACION
Authorized Official Telephone Number:
787-653-5353

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , 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)

  • Identifier: 3753 . This is a "PREFERRED MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 991927 . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060248 . This is a "CRUZ AZUL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204369 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212978 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200415 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201717 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9984 . This is a "FIRST PLUS" identifier . This identifiers is of the category "OTHER".




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