Provider Demographics
NPI:1801842661
Name:EMERGENCY MEDICINE GROUP OF ARECIBO INC
Entity type:Organization
Organization Name:EMERGENCY MEDICINE GROUP OF ARECIBO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-879-5704
Mailing Address - Street 1:PO BOX 9975
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-879-5704
Mailing Address - Fax:787-817-3759
Practice Address - Street 1:CARR 129
Practice Address - Street 2:SALA EMERGENCIA HOSPITAL METROPOLITANO CAYETANO COLLY
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-5704
Practice Address - Fax:787-817-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
88762Medicare ID - Type Unspecified