Provider Demographics
NPI:1831205715
Name:ADVANCED MRI GROUP OF PR,P.S.C.
Entity type:Organization
Organization Name:ADVANCED MRI GROUP OF PR,P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:GASPAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-263-0644
Mailing Address - Street 1:PMB 359 #701-1
Mailing Address - Street 2:AVE. PONCE DE LEON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3570
Mailing Address - Country:US
Mailing Address - Phone:787-263-0644
Mailing Address - Fax:787-535-1024
Practice Address - Street 1:BO RINCON CARR 14 KM 72.2
Practice Address - Street 2:EDIF. PROFESIONAL HOSPITAL MENONITA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-0644
Practice Address - Fax:787-535-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
20165Medicare ID - Type Unspecified
20042Medicare ID - Type Unspecified
20071Medicare ID - Type Unspecified