Provider Demographics
NPI:1760698096
Name:ADM SERVICIOS MEDICOS DE PUERTO RICO
Entity Type:Organization
Organization Name:ADM SERVICIOS MEDICOS DE PUERTO RICO
Other - Org Name:CENTRO MEDICO
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLER OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-777-3483
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2129
Mailing Address - Country:US
Mailing Address - Phone:787-777-3483
Mailing Address - Fax:787-777-3481
Practice Address - Street 1:AVE AMERICO MIRANDA
Practice Address - Street 2:NO 22 BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-2129
Practice Address - Country:US
Practice Address - Phone:787-777-3483
Practice Address - Fax:787-777-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QD0000X
261QH0100X, 261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1000042OtherHUMANA
PR067019OtherCRUZ AZUL
PR28345OtherSSS
PR067019OtherCRUZ AZUL
PR=========OtherMCS
PR=========OtherIMC