Provider Demographics
NPI:1225802606
Name:INSTITUTO MEDICO DEL NORTE INC
Entity Type:Organization
Organization Name:INSTITUTO MEDICO DEL NORTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:939-940-8572
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-7001
Mailing Address - Country:US
Mailing Address - Phone:787-858-1580
Mailing Address - Fax:
Practice Address - Street 1:REPARTO METROPOLITANO SHOPPING CENTER
Practice Address - Street 2:SUITE 26A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-858-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTO MEDICO DEL NORTE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology