MEDICARE: INTERNATIONAL MEDICAL SOLUTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1528525771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL MEDICAL SOLUTION LLC

Provider Business Mailing Address
First Line	:	PO BOX 3825
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970-3825
Country	:	US
Telephone Number	:	787-504-9998
Fax Number	:	787-759-8411

Provider Business Practice Location Address
First Line	:	1 CALLE SANTA ROSA SAN JUAN GARDEN
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00926-0092
Country	:	US
Telephone Number	:	787-766-0075
Fax Number	:	787-759-8411

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MANUEL ANTONIO PLACER
Credential	:
Telephone Number	:	787-504-9998

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	02/25/2019

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