Provider Demographics
NPI:1679734552
Name:INTERNAL MEDICINE INTEGRATED SERVICES PSC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE INTEGRATED SERVICES PSC
Other - Org Name:IMIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC 7930
Authorized Official - Phone:787-854-3851
Mailing Address - Street 1:J23 CALLE ELLIOT VELEZ
Mailing Address - Street 2:URB ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4616
Mailing Address - Country:US
Mailing Address - Phone:787-854-3851
Mailing Address - Fax:787-854-3851
Practice Address - Street 1:J23 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3851
Practice Address - Fax:787-854-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR212407OtherPREFERRED HEALTH PLAN
PR04715OtherAMERICAN HEALTH INC
PR1380OtherAMERICAN HEALTH MEDICARE
PR4254OtherFISRT PLUS
PRPE2000OtherPALIC
PR069646OtherCRUZ AZUL
PR1653OtherPMC MEDICARE CHOICE
PR100233OtherMEDICARE Y MUCHO MAS
PR7530053OtherHUMANA
PR81764OtherTRIPLE S, INC
PR04715OtherAMERICAN HEALTH INC
PR1653OtherPMC MEDICARE CHOICE
PR=========OtherMAPFRE