Provider Demographics
NPI:1720389034
Name:M O PRIMARY SPECIALISTS PSC
Entity Type:Organization
Organization Name:M O PRIMARY SPECIALISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-254-3410
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0652
Mailing Address - Country:US
Mailing Address - Phone:787-254-3410
Mailing Address - Fax:787-254-3410
Practice Address - Street 1:25 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4029
Practice Address - Country:US
Practice Address - Phone:787-254-3410
Practice Address - Fax:787-254-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service