Provider Demographics
NPI:1164771853
Name:COLONIAL MEDICAL MANAGEMENT, CORP
Entity Type:Organization
Organization Name:COLONIAL MEDICAL MANAGEMENT, CORP
Other - Org Name:COMEDCO IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-943-7889
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-1438
Mailing Address - Country:US
Mailing Address - Phone:787-826-8082
Mailing Address - Fax:787-229-1091
Practice Address - Street 1:CARR 402 KM 1.8 BO MARIAS
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-8082
Practice Address - Fax:787-229-1091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLONIAL MEDICAL MANAGEMENT, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography