Healthcare Provider Details

I. General information

NPI: 1396524856
Provider Name (Legal Business Name): PRIMARY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MENDEZ VIGO #24
PONCE PR
00730
US

IV. Provider business mailing address

PO BOX 336149
PONCE PR
00733-6149
US

V. Phone/Fax

Practice location:
  • Phone: 787-492-3197
  • Fax: 787-840-8874
Mailing address:
  • Phone: 787-492-3197
  • Fax: 787-840-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGIO CHEVERE MOURINO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-844-0331