Provider Demographics
NPI:1881926285
Name:GRUPO DE MEDICOS PRIMARIOS DEL SUR INC
Entity type:Organization
Organization Name:GRUPO DE MEDICOS PRIMARIOS DEL SUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:NOELIS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-313-5032
Mailing Address - Street 1:PO BOX 2187
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2181
Mailing Address - Country:US
Mailing Address - Phone:787-313-5032
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE RAFAEL OCASIO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3238
Practice Address - Country:US
Practice Address - Phone:787-313-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR194080OtherREGISTRATION DEPT OF STATE