Provider Demographics
NPI:1316189533
Name:GRUPO IMAGENES RADIOLOGICAS DEL NOROESTE CSP
Entity Type:Organization
Organization Name:GRUPO IMAGENES RADIOLOGICAS DEL NOROESTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-658-0612
Mailing Address - Street 1:1 CALLE LUIS ESTEFANI
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-5926
Mailing Address - Country:US
Mailing Address - Phone:787-658-0612
Mailing Address - Fax:787-658-0612
Practice Address - Street 1:1 CALLE LUIS ESTEFANI
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-5926
Practice Address - Country:US
Practice Address - Phone:787-658-0612
Practice Address - Fax:787-658-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD99526Medicare UPIN