Provider Demographics
NPI:1629261011
Name:PUERTO RICO MEDICAL EMERGENCY GROUP P.S.C.
Entity Type:Organization
Organization Name:PUERTO RICO MEDICAL EMERGENCY GROUP P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLON GRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-528-3329
Mailing Address - Street 1:PMB 157
Mailing Address - Street 2:100 GRAND PASEOS BLVD SUITE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5902
Mailing Address - Country:US
Mailing Address - Phone:787-528-3329
Mailing Address - Fax:787-714-0058
Practice Address - Street 1:HOSPITAL EPISCOPAL SAN LUCAS
Practice Address - Street 2:917 AVE TITO CASTRO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:787-841-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR59414Medicare PIN