Provider Demographics
NPI:1700115532
Name:GRUPO MEDICO SERVICIOS MEDICOS RUM
Entity type:Organization
Organization Name:GRUPO MEDICO SERVICIOS MEDICOS RUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHANCELLOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERA SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-832-4040
Mailing Address - Street 1:PO BOX 9039
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-9039
Mailing Address - Country:US
Mailing Address - Phone:787-265-3865
Mailing Address - Fax:787-834-3031
Practice Address - Street 1:259 ALFONSO VALDEZBLVD.
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-3865
Practice Address - Fax:787-834-3031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECINTO UNIVERSITARIO DE MAYAGUEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134244577OtherNPI FOR THE FACILITY AND LABORATORY SERVICIES