Provider Demographics
NPI:1669470514
Name:CRITICAL CARE MEDICINE SERVICES, INC.
Entity Type:Organization
Organization Name:CRITICAL CARE MEDICINE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAOLI-BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-381-0247
Mailing Address - Street 1:PO BOX 193789
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3789
Mailing Address - Country:US
Mailing Address - Phone:787-381-0247
Mailing Address - Fax:787-755-9005
Practice Address - Street 1:1276 CALLE 54 SE
Practice Address - Street 2:URB. LA RIVIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3141
Practice Address - Country:US
Practice Address - Phone:787-381-0247
Practice Address - Fax:787-755-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12292207QG0300X
PR7355207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029134Medicare PIN