Provider Demographics
NPI:1821244179
Name:SOUTHERN INTERNAL MEDICINE, P.S.C
Entity Type:Organization
Organization Name:SOUTHERN INTERNAL MEDICINE, P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-984-0908
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0320
Mailing Address - Country:US
Mailing Address - Phone:787-984-0908
Mailing Address - Fax:787-984-1139
Practice Address - Street 1:2279 PONCE BYP
Practice Address - Street 2:CARIBBEAN MEDICAL CENTER
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-984-0908
Practice Address - Fax:787-984-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty