Provider Demographics
NPI:1609492248
Name:GRUPO INTEGRADO MEDICINA PRIMARIA INC
Entity Type:Organization
Organization Name:GRUPO INTEGRADO MEDICINA PRIMARIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING & COLLECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1715
Practice Address - Street 1:CARRETERA 173 KM 1.1
Practice Address - Street 2:AVENIDA LUIS COLON SANTOS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1650
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty