Provider Demographics
NPI:1093723462
Name:SERVICIOS MEDICOS PRIMARIOS DE BARRANQUITAS, INC
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS PRIMARIOS DE BARRANQUITAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-857-1987
Mailing Address - Street 1:103 CALLE BARCELO
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1605
Mailing Address - Country:US
Mailing Address - Phone:787-857-1987
Mailing Address - Fax:
Practice Address - Street 1:103 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1605
Practice Address - Country:US
Practice Address - Phone:787-857-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10723261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082922Medicare ID - Type Unspecified
PRF47606Medicare UPIN