Provider Demographics
NPI:1225144314
Name:JARS INTERNAL MEDICINE PSC
Entity Type:Organization
Organization Name:JARS INTERNAL MEDICINE PSC
Other - Org Name:JARS INTERNAL MEDICINE PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-832-4545
Mailing Address - Street 1:246 CALLE RAMOS ANTONINI
Mailing Address - Street 2:URB PONCE DE LEON
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5135
Mailing Address - Country:US
Mailing Address - Phone:787-832-4545
Mailing Address - Fax:787-834-1228
Practice Address - Street 1:CALLE DE DIEGO 55 ESTE
Practice Address - Street 2:SUITE 102 CPR BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-4545
Practice Address - Fax:787-834-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41001Medicare UPIN
PR0088486Medicare PIN