Provider Demographics
NPI:1780632638
Name:INTERMED PRIMARY CARE
Entity Type:Organization
Organization Name:INTERMED PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA DE FACTURACION
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-5353
Mailing Address - Street 1:PO BOX 7589
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7589
Mailing Address - Country:US
Mailing Address - Phone:787-653-5353
Mailing Address - Fax:787-653-5364
Practice Address - Street 1:AVE. LUIS MUNOZ MARIN ESQ. GEORGETTI
Practice Address - Street 2:EDIF. ANGORA PARK 2DO NIVEL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-5353
Practice Address - Fax:787-653-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
3753OtherPREFERRED MEDICARE CHOICE
991927OtherMEDICARE Y MUCHO MAS
060248OtherCRUZ AZUL
204369OtherPREFERRED HEALTH
212978OtherPREFERRED HEALTH
200415OtherPREFERRED HEALTH
201717OtherPREFERRED HEALTH
9984OtherFIRST PLUS
060248OtherCRUZ AZUL
200415OtherPREFERRED HEALTH
=========OtherCOSVI
991927OtherMEDICARE Y MUCHO MAS
=========OtherCOSVI
200415OtherPREFERRED HEALTH
=========OtherPAN AMERICAN LIFE
0021882Medicare ID - Type Unspecified