Provider Demographics
NPI:1396844320
Name:ST JUDE URGENCY CARE GROUP PSC
Entity Type:Organization
Organization Name:ST JUDE URGENCY CARE GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-0736
Mailing Address - Street 1:PO BOX 9117
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9117
Mailing Address - Country:US
Mailing Address - Phone:787-614-0736
Mailing Address - Fax:
Practice Address - Street 1:1214 CALLE JOSE ABAD
Practice Address - Street 2:CLUB MANOR
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924-4336
Practice Address - Country:US
Practice Address - Phone:787-257-0765
Practice Address - Fax:787-757-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty