Provider Demographics
NPI:1326523119
Name:SERVICIOS MEDICOS DE PUERTO RICO INC
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS DE PUERTO RICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-4357
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1895
Mailing Address - Country:US
Mailing Address - Phone:787-892-4357
Mailing Address - Fax:787-659-7120
Practice Address - Street 1:AVE. INTERAMERICANA #153 CALLE CHILLIN QUINONES
Practice Address - Street 2:EDIF SAN JOSE #3
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-4357
Practice Address - Fax:787-659-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty