Provider Demographics
NPI:1275778003
Name:NORTHERN MEDICAL SERVICES GROUP COPR
Entity Type:Organization
Organization Name:NORTHERN MEDICAL SERVICES GROUP COPR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-940-8715
Mailing Address - Street 1:PO BOX 9415
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9415
Mailing Address - Country:US
Mailing Address - Phone:939-940-8715
Mailing Address - Fax:787-883-4434
Practice Address - Street 1:CALLE COLON # 106
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3166
Practice Address - Country:US
Practice Address - Phone:939-940-8715
Practice Address - Fax:787-883-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183250261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR183250Other183250 REGISTER CERTIFIED