Provider Demographics
NPI:1629063151
Name:INSTITUTO DE GASTROENTEROLOGIA DE PR
Entity Type:Organization
Organization Name:INSTITUTO DE GASTROENTEROLOGIA DE PR
Other - Org Name:INSTITUTO DE GASTROENTEROLOGIA DE PR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-764-8787
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:CLINICA LAS AMERICAS SUITE 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2103
Mailing Address - Country:US
Mailing Address - Phone:787-764-8787
Mailing Address - Fax:787-250-1029
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:CLINICA LAS AMERICAS SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-764-8787
Practice Address - Fax:787-250-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18852Medicare ID - Type Unspecified
PRW55137Medicare UPIN