1588776090 NPI number — INTERNATIONAL MEDICAL CENTER CORP

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 1588776090 NPI number — INTERNATIONAL MEDICAL CENTER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL MEDICAL CENTER CORP
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:
1588776090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ST DE LA VERA D8
Provider Second Line Business Mailing Address:
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:
787-288-8252
Provider Business Mailing Address Fax Number:
787-786-8234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D8 CALLE DE LA VERA
Provider Second Line Business Practice Location Address:
VILLA ESPANA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-288-8252
Provider Business Practice Location Address Fax Number:
787-786-8234
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEVRES
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-288-8252

Provider Taxonomy Codes

  • Taxonomy code: 246XS1301X , 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)





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