Provider Demographics
NPI:1609083377
Name:GRP MED CT RADIOLOGY COMPLEX
Entity Type:Organization
Organization Name:GRP MED CT RADIOLOGY COMPLEX
Other - Org Name:CT RADIOLOGY COMPLEX LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORISELLE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RIVERA POL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-621-3724
Mailing Address - Street 1:PO BOX 602727
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6037
Mailing Address - Country:US
Mailing Address - Phone:787-780-9069
Mailing Address - Fax:787-780-2121
Practice Address - Street 1:1815 CARR. #2
Practice Address - Street 2:CT RADIOLOGY BULDING
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7279
Practice Address - Country:US
Practice Address - Phone:787-780-9069
Practice Address - Fax:787-780-2121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CT RADIOLOGY COMPLEX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRS80101OtherTRIPLE
PRS80101OtherTRIPLE