Provider Demographics
NPI:1902883242
Name:KYRIOS INTERNAL MEDICINE SERVICES
Entity Type:Organization
Organization Name:KYRIOS INTERNAL MEDICINE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-7095
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1492
Mailing Address - Country:US
Mailing Address - Phone:787-872-7095
Mailing Address - Fax:787-872-7095
Practice Address - Street 1:7342 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3466
Practice Address - Country:US
Practice Address - Phone:787-872-7095
Practice Address - Fax:787-872-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
212571OtherUTI
89563R10OtherSSS
PE3701OtherCANADA LIFE
89563OtherMEDICARE OPTIMOR
6620043OtherHUMANA
9864OtherINTCARD
1849OtherPMC
30255OtherAMPR
100193OtherCRUZ AZUL
100097WOtherMMM
PE307OtherPARLIC
PE307OtherPARLIC
30255OtherAMPR
89563OtherMEDICARE OPTIMOR
=========OtherAARP
=========OtherMCS CLASSICARE
=========OtherFIRST PLUS
G73640Medicare UPIN