Provider Demographics
NPI:1285008797
Name:MMC FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MMC FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-621-3724
Mailing Address - Street 1:100 CARR 165 TOWER 1
Mailing Address - Street 2:SUITE 508
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-8052
Mailing Address - Country:US
Mailing Address - Phone:787-621-3724
Mailing Address - Fax:787-621-3715
Practice Address - Street 1:CARR 687 KM 0.1
Practice Address - Street 2:BO. ALGARROBO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0000
Practice Address - Country:US
Practice Address - Phone:787-621-3724
Practice Address - Fax:787-621-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care