Provider Demographics
NPI:1356402978
Name:PRIMARY PHISICIAN EMERGENCY GROUP
Entity type:Organization
Organization Name:PRIMARY PHISICIAN EMERGENCY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-5790
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1388
Mailing Address - Country:US
Mailing Address - Phone:787-746-5790
Mailing Address - Fax:787-744-8065
Practice Address - Street 1:AVE RAFAEL CORDERO FINAL
Practice Address - Street 2:ESQ TROCHE Y SANTIAGO CDT
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-0530
Practice Address - Fax:787-743-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F2141333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4024345OtherNCPDP
PR07F2141OtherPHARMACY LICENCE
PR07F2141OtherPHARMACY LICENCE