Basic Information
| Provider Information | |||||||||
| NPI: | 1871959387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS CARE PHYSICIANS OF PUERTO RICO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743809 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
| FaxNumber: | 4849240053 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 584 KM 0.4 | ||||||||
| Address2: | PARQUE INDUSTRIAL AMUELAS | ||||||||
| City: | JUANA DIAZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007952871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872606670 | ||||||||
| FaxNumber: | 7872606976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6106448900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.