1841200870 NPI number — EASTERN PRIMARY MEDICAL SERVICES, P.S.C.

Table of content: (NPI 1841200870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841200870 NPI number — EASTERN PRIMARY MEDICAL SERVICES, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PRIMARY MEDICAL SERVICES, P.S.C.
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:
1841200870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-737-6082
Provider Business Mailing Address Fax Number:
787-737-6082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D12 CALLE 1
Provider Second Line Business Practice Location Address:
URB. EL VIVERO
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-737-6082
Provider Business Practice Location Address Fax Number:
787-737-6082
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANABRIA
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-737-6082

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 065428 . This is a "LA CRUZ AZUL - PROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1304 . This is a "INTER MED CARD - PROV #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0085450A . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 584266586 . This is a "COSVI - PROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2011627 . This is a "PREFERRED HEALTH - # PROV" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 775171 . This is a "HUMANA GOLD PLUS - PROV#" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 04351 . This is a "AMERICAN HEALTH - PROV #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: MEDICARE Y MUCHO MAS . This is a "500117SE - PROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0085450 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3511A . This is a "PREFERR MED CHOI - PROV#" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6580008 . This is a "HUMANA PR -ROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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