Provider Demographics
NPI:1497120034
Name:INTEGRATE COMMUNITY HEALTH SYSTEM
Entity Type:Organization
Organization Name:INTEGRATE COMMUNITY HEALTH SYSTEM
Other - Org Name:METRO PAVIA CLINIC CAGUAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-234-8865
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:PMB 455
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-772-9850
Mailing Address - Fax:787-274-8895
Practice Address - Street 1:C8 AVE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-772-9850
Practice Address - Fax:787-274-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology