Provider Demographics
NPI:1023664042
Name:SOUTH PRIME OB-GYN LLC
Entity type:Organization
Organization Name:SOUTH PRIME OB-GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LENNY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-633-9260
Mailing Address - Street 1:1124 AVE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0643
Mailing Address - Country:US
Mailing Address - Phone:787-633-9260
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DAMAS
Practice Address - Street 2:2213 PONCE BYPASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-633-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty