1467736702 NPI number — THE PALMS INTERVENTIONAL PAIN CLINIC, PSC

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 1467736702 NPI number — THE PALMS INTERVENTIONAL PAIN CLINIC, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PALMS INTERVENTIONAL PAIN CLINIC, 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:
THE PALMS CLINIC
Provider Other Organization Name Type Code:
5
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:
1467736702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. VALLE ARRIBA HEIGHTS
Provider Second Line Business Mailing Address:
ST. 110 BH 2
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-200-0350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 167 # INT839
Provider Second Line Business Practice Location Address:
SECTOR LA ALDEA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-200-0350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-200-0350

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  16381 , 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: CY164A . This is a "PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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