Provider Demographics
NPI:1841200870
Name:EASTERN PRIMARY MEDICAL SERVICES, P.S.C.
Entity Type:Organization
Organization Name:EASTERN PRIMARY MEDICAL SERVICES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-737-6082
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1323
Mailing Address - Country:US
Mailing Address - Phone:787-737-6082
Mailing Address - Fax:787-737-6082
Practice Address - Street 1:D12 CALLE 1
Practice Address - Street 2:URB. EL VIVERO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2301
Practice Address - Country:US
Practice Address - Phone:787-737-6082
Practice Address - Fax:787-737-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR065428OtherLA CRUZ AZUL - PROVIDER #
PR1304OtherINTER MED CARD - PROV #
PR0085450AOtherMEDICARE
PR584266586OtherCOSVI - PROVIDER #
PR2011627OtherPREFERRED HEALTH - # PROV
PR775171OtherHUMANA GOLD PLUS - PROV#
PR04351OtherAMERICAN HEALTH - PROV #
PRMEDICARE Y MUCHO MASOther500117SE - PROVIDER #
PR0085450OtherMEDICARE
PR3511AOtherPREFERR MED CHOI - PROV#
PR6580008OtherHUMANA PR -ROVIDER #
PRMEDICARE Y MUCHO MASOther500117SE - PROVIDER #
PR775171OtherHUMANA GOLD PLUS - PROV#