Provider Demographics
NPI:1841511730
Name:PRIMEDICA, INC.
Entity type:Organization
Organization Name:PRIMEDICA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-3960
Mailing Address - Street 1:P. O. BOX 1118
Mailing Address - Street 2:EDIF. HORMIGUEROS PLAZA SUITE #8
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAN ANTONIO 212
Practice Address - Street 2:EDIF. HORMIGUEROS PLAZA SUITE #8
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-0000
Practice Address - Country:US
Practice Address - Phone:787-849-3960
Practice Address - Fax:787-849-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRN/A305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization