Provider Demographics
NPI:1093999674
Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC.
Other - Org Name:METROPOLITAN COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORENGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-641-4234
Mailing Address - Street 1:400 CALAF STREET PMB 455
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-772-9850
Mailing Address - Fax:787-274-8895
Practice Address - Street 1:DR. ISAAC GONZALEZ STREET, URB. PEREZ MATOS
Practice Address - Street 2:EN HOSPITAL METROPOLITANO DE LA MONTANA
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-933-0150
Practice Address - Fax:787-933-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20736OtherMEDICARE