Healthcare Provider Details

I. General information

NPI: 1811451883
Provider Name (Legal Business Name): PRYMED MEDICAL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE #2 KM 39.8 BO ALGARROBO
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1427
CIALES PR
00638-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax: 787-871-3960
Mailing address:
  • Phone: 787-871-0601
  • Fax: 787-871-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARISOL VEGA DE JESUS
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 787-871-0601