Provider Demographics
NPI:1801134978
Name:PRIMARY INTERNAL CARE PSC
Entity type:Organization
Organization Name:PRIMARY INTERNAL CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:BAEZ
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-717-9840
Mailing Address - Street 1:PRADERAS DE RIO FLORES 113
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:939-717-9840
Mailing Address - Fax:
Practice Address - Street 1:PLAZA ISABELLA LOCAL 2 BO MACHUCHAL
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:939-717-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREK244AOtherPTAN MEDICARE