Provider Demographics
NPI:1417093493
Name:ADVANCED MEDICAL CONCEPTS PSC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CONCEPTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAURY
Authorized Official - Middle Name:ARNALDO
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-739-3376
Mailing Address - Street 1:PO BOX 1802
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1802
Mailing Address - Country:US
Mailing Address - Phone:787-739-3376
Mailing Address - Fax:787-714-1134
Practice Address - Street 1:4 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3318
Practice Address - Country:US
Practice Address - Phone:787-739-3376
Practice Address - Fax:787-714-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5872261Q00000X
GA057659261Q00000X
MI4301087098261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR587OtherAMERICAN HEALTH MEDICARE
PR6390017OtherHUMANA
PRM 00121OtherMENONITA HEALTH PLAN
PR400271OtherMMM PROVIDER
PR2156AOtherPREFFERED MEDICARE CHOICE
PR27251OtherSSS
PR65719OtherCRUZ AZUL
PR6390017OtherHUMANA
PR=========OtherMCS CLASSICARE
PR27251OtherSSS
PR400271OtherMMM PROVIDER
PR65719OtherCRUZ AZUL
PR=========OtherMCS CLASSICARE