Provider Demographics
NPI:1225169063
Name:IMC GROUP
Entity Type:Organization
Organization Name:IMC GROUP
Other - Org Name:IMC (ULTRASOUND) GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHEVRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-995-0861
Mailing Address - Street 1:D8 CALLE DE LA VERA
Mailing Address - Street 2:URB. VILLA ESPANA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-995-0861
Mailing Address - Fax:787-995-0545
Practice Address - Street 1:AVE AGUAS BUENAS #36 EDIF. TORRES CASTRO
Practice Address - Street 2:URB. SANTA ROSA (131Q .16-34)
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-995-0861
Practice Address - Fax:787-995-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty