Provider Demographics
NPI:1992036974
Name:ALLIED SELECT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ALLIED SELECT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:SANTOS AMEZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-862-4417
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0953
Mailing Address - Country:US
Mailing Address - Phone:787-862-4417
Mailing Address - Fax:787-862-7646
Practice Address - Street 1:5 CALLE BUENA VIS
Practice Address - Street 2:SUITE 1
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3042
Practice Address - Country:US
Practice Address - Phone:787-862-4417
Practice Address - Fax:787-862-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization