Provider Demographics
NPI:1790994218
Name:EIDER MEDICAL GROUP PSC
Entity Type:Organization
Organization Name:EIDER MEDICAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-768-6996
Mailing Address - Street 1:PO BOX 29454
Mailing Address - Street 2:65TH INFANTRY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0454
Mailing Address - Country:US
Mailing Address - Phone:787-768-6996
Mailing Address - Fax:787-768-6996
Practice Address - Street 1:939 CALLE EIDER
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2335
Practice Address - Country:US
Practice Address - Phone:787-768-6996
Practice Address - Fax:787-768-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center