Provider Demographics
NPI:1144568098
Name:AGM-GE,LLC
Entity Type:Organization
Organization Name:AGM-GE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-449-2201
Mailing Address - Street 1:33 CALLE AMBER
Mailing Address - Street 2:TREASURE POINT
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-8917
Mailing Address - Country:US
Mailing Address - Phone:787-449-2201
Mailing Address - Fax:787-854-0403
Practice Address - Street 1:J23 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-0404
Practice Address - Fax:787-854-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13604207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13604OtherLICENSE
PR0021143OtherMEDICARE
PR207RG0100XOtherTAXONOMY
PRH79752Medicare UPIN