Provider Demographics
NPI:1558589788
Name:EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP
Entity Type:Organization
Organization Name:EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP
Other - Org Name:EDMS,CSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD MHSA
Authorized Official - Phone:787-721-2160
Mailing Address - Street 1:ESTANCIAS DE SAN FERNANDO
Mailing Address - Street 2:STREET #4 B-17
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5213
Mailing Address - Country:US
Mailing Address - Phone:787-721-2160
Mailing Address - Fax:787-722-8016
Practice Address - Street 1:1451 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-725-5613
Practice Address - Fax:787-725-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83822Medicare PIN