Provider Demographics
NPI:1174593545
Name:PRIMARY MEDICAL GROUP,C.S.P.
Entity type:Organization
Organization Name:PRIMARY MEDICAL GROUP,C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:IRAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL RIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-813-0080
Mailing Address - Street 1:PO BOX 336149
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6149
Mailing Address - Country:US
Mailing Address - Phone:787-813-0257
Mailing Address - Fax:787-840-8874
Practice Address - Street 1:CALLE FERROCARRIL
Practice Address - Street 2:# 607
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1195
Practice Address - Country:US
Practice Address - Phone:787-813-0257
Practice Address - Fax:787-840-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82722Medicare ID - Type Unspecified