Provider Demographics
NPI:1013975069
Name:NEUROCARDIAC GROUP INC
Entity type:Organization
Organization Name:NEUROCARDIAC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-257-0060
Mailing Address - Street 1:PO BOX 10100
Mailing Address - Street 2:PLAZA CAROLINA STA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-1100
Mailing Address - Country:US
Mailing Address - Phone:787-257-0060
Mailing Address - Fax:
Practice Address - Street 1:COND GOLDEN TOWER
Practice Address - Street 2:SUITE 3A
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1899
Practice Address - Country:US
Practice Address - Phone:787-257-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93498261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87888Medicare ID - Type Unspecified