Provider Demographics
NPI:1043567068
Name:EASTERN INDUSTRIAL MEDICAL SERVICES,INC.
Entity Type:Organization
Organization Name:EASTERN INDUSTRIAL MEDICAL SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-285-3919
Mailing Address - Street 1:PO BOX 8085
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8085
Mailing Address - Country:US
Mailing Address - Phone:787-285-3919
Mailing Address - Fax:787-285-3919
Practice Address - Street 1:AA3 AVE TEJAS
Practice Address - Street 2:FRENTE UPR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4351
Practice Address - Country:US
Practice Address - Phone:787-285-3919
Practice Address - Fax:787-285-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13148261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-0419Medicare PIN
PRH35854Medicare UPIN