Provider Demographics
NPI:1568543676
Name:INTERNATIONAL MANAGE CARE SERVICE OF PUERTO RICO
Entity Type:Organization
Organization Name:INTERNATIONAL MANAGE CARE SERVICE OF PUERTO RICO
Other - Org Name:IMCS OF PR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHDC, CPUM, CPUR
Authorized Official - Phone:787-726-9620
Mailing Address - Street 1:1870-A SAN ANTONIO STREET
Mailing Address - Street 2:PARADA 26
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-726-9620
Mailing Address - Fax:787-726-1720
Practice Address - Street 1:1870-A SAN ANTONIO STREET
Practice Address - Street 2:PARADA 26
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-726-9620
Practice Address - Fax:787-726-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization