Provider Demographics
NPI:1861481673
Name:AMMVR GROUP, INC
Entity Type:Organization
Organization Name:AMMVR GROUP, INC
Other - Org Name:IMRL CLINICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR DE FINANZAS
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:879-992-9907
Mailing Address - Street 1:PO BOX 195519
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5519
Mailing Address - Country:US
Mailing Address - Phone:787-999-2990
Mailing Address - Fax:787-764-8809
Practice Address - Street 1:11E DOMINGO CACERES
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00985
Practice Address - Country:UM
Practice Address - Phone:787-762-8111
Practice Address - Fax:787-752-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR449291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38292Medicare ID - Type Unspecified