Provider Demographics
NPI:1407053788
Name:GRUPO MEDICINA INTERNA HMSJ
Entity Type:Organization
Organization Name:GRUPO MEDICINA INTERNA HMSJ
Other - Org Name:FACULTAD MEDICA HOSPITAL MUNICIPAL SJ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-766-2222
Mailing Address - Street 1:HOSPITAL MUNICIPAL 201
Mailing Address - Street 2:CENTRO MEDICO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-766-2222
Mailing Address - Fax:787-765-4975
Practice Address - Street 1:HOSPITAL MUNICIPAL 201
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-766-2222
Practice Address - Fax:787-765-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028045Medicare ID - Type UnspecifiedGRUPO MEDICINA INTERNA HM