Provider Demographics
NPI:1013104462
Name:ADVANCED MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVERA USERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-747-6300
Mailing Address - Street 1:HACIENDA SAN JOSE
Mailing Address - Street 2:1001 CALLE ALMACIGOS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3120
Mailing Address - Country:US
Mailing Address - Phone:787-747-6300
Mailing Address - Fax:787-961-5501
Practice Address - Street 1:SUITE 7 CENTRO COMERCIAL VALLE TOLIMA
Practice Address - Street 2:285 AVE REGIMIENTO DE INFANTERIA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-747-6300
Practice Address - Fax:787-961-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15449261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDE607AMedicare PIN
PR22736Medicare PIN