Provider Demographics
NPI:1801047246
Name:MEDICAL SERVICES GROUP PSP
Entity type:Organization
Organization Name:MEDICAL SERVICES GROUP PSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-223-1636
Mailing Address - Street 1:34 CALLE PRINCIPAL
Mailing Address - Street 2:VILLA ALTAMIRA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4200
Mailing Address - Country:US
Mailing Address - Phone:787-817-3392
Mailing Address - Fax:
Practice Address - Street 1:ARECIBO MEDICAL PLAZA
Practice Address - Street 2:JOSE CEJSO BARBOSA AVE SUIT 4
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0612
Practice Address - Country:US
Practice Address - Phone:787-817-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization