Provider Demographics
NPI:1548733421
Name:IMG HOSPITAL CARE LLC
Entity Type:Organization
Organization Name:IMG HOSPITAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-872-8162
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-9438
Mailing Address - Country:US
Mailing Address - Phone:787-452-5504
Mailing Address - Fax:
Practice Address - Street 1:700 CALLE DIALY STE 203
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-5104
Practice Address - Country:US
Practice Address - Phone:787-872-8162
Practice Address - Fax:787-872-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty