=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871959387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS CARE PHYSICIANS OF PUERTO RICO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2016
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 584 KM 0.4 PARQUE INDUSTRIAL AMUELAS
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795-2871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-6670
-----------------------------------------------------
Fax | 787-260-6976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 743809
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-8900
-----------------------------------------------------
Fax | 484-924-0053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREGG MILLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-515-4048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------