Provider Demographics
NPI:1346414679
Name:GRUPO RESCUE
Entity Type:Organization
Organization Name:GRUPO RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-235-9920
Mailing Address - Street 1:3508 NW 114 AVE
Mailing Address - Street 2:BM 30095, PMB
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:305-235-9920
Mailing Address - Fax:305-675-7836
Practice Address - Street 1:CARR BAVARO, EDIFRICIO CENTRO MEDICO PUNTA CANA
Practice Address - Street 2:E/ FRIUSA Y PLAZA BAVARO
Practice Address - City:BAVARO
Practice Address - State:LA ALTAGRACIA
Practice Address - Zip Code:23000
Practice Address - Country:DO
Practice Address - Phone:809-552-1506
Practice Address - Fax:809-552-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care