1619131406 NPI number — INTERNAL MEDICINE PERIOPERATIVE CONSULTANTS PSC

Table of content: (NPI 1619131406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619131406 NPI number — INTERNAL MEDICINE PERIOPERATIVE CONSULTANTS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE PERIOPERATIVE CONSULTANTS 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:
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:
1619131406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
PMB 157
Provider Business Mailing Address City Name:
MERCEDITA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-841-5549
Provider Business Mailing Address Fax Number:
787-840-3030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 TITO CASTRO AVE
Provider Second Line Business Practice Location Address:
TORRE MEDICA SAN LUCAS SUITE 717
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-453-0583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-453-0583

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  14914 , 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: 5200 . This is a "PUERTO RICO DEPARTMENT OF STATE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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