Provider Demographics
NPI:1780633651
Name:SOUTHERN INTERNAL MEDICINE GROUP, INC.
Entity Type:Organization
Organization Name:SOUTHERN INTERNAL MEDICINE GROUP, INC.
Other - Org Name:SOUTHERN INTERNAL MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BENITEZ LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-1248
Mailing Address - Street 1:PO BOX 7819
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7819
Mailing Address - Country:US
Mailing Address - Phone:787-844-1248
Mailing Address - Fax:787-290-0706
Practice Address - Street 1:2225 PONCE BYE PASS STE 302
Practice Address - Street 2:EDIFICIO PARRA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-844-1248
Practice Address - Fax:787-290-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty