Basic Information
| Provider Information | |||||||||
| NPI: | 1629261011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUERTO RICO MEDICAL EMERGENCY GROUP P.S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PMB 157 | ||||||||
| Address2: | 100 GRAND PASEOS BLVD SUITE 112 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009265902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875283329 | ||||||||
| FaxNumber: | 7877140058 | ||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL EPISCOPAL SAN LUCAS | ||||||||
| Address2: | 917 AVE TITO CASTRO | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | 7878413454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 03/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | COLON GRAU | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7875283329 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.