1225169063 NPI number — IMC GROUP

Table of content: (NPI 1225169063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225169063 NPI number — IMC GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMC GROUP
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:
6
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:
1225169063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
D8 CALLE DE LA VERA
Provider Second Line Business Mailing Address:
URB. VILLA ESPANA
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-995-0861
Provider Business Mailing Address Fax Number:
787-995-0545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE AGUAS BUENAS #36 EDIF. TORRES CASTRO
Provider Second Line Business Practice Location Address:
URB. SANTA ROSA (131Q .16-34)
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-995-0861
Provider Business Practice Location Address Fax Number:
787-995-0545
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHEVRES
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-995-0861

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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