Provider Demographics
NPI:1609073063
Name:INTERNAL COUNCIL MEDICINE ENHANCE, PSC
Entity Type:Organization
Organization Name:INTERNAL COUNCIL MEDICINE ENHANCE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAWYER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOOLARD
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:787-296-9767
Mailing Address - Street 1:PO BOX 7303
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7303
Mailing Address - Country:US
Mailing Address - Phone:787-296-9767
Mailing Address - Fax:787-296-9767
Practice Address - Street 1:140 JOSE DE DIEGO
Practice Address - Street 2:ARENAS EXIT
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1838
Practice Address - Country:US
Practice Address - Phone:787-739-9495
Practice Address - Fax:787-296-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R00000X251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFEDERAL TAX ID
PR0083318Medicare ID - Type UnspecifiedMEDICARE
PRF56477Medicare UPIN