MEDICARE: IMPERIAL MEDICAL SERVICES, C. S. P.

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	208D00000X	General Practice Physician	009228	PR

General Provider Information

NPI Number	:	1952741886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL MEDICAL SERVICES, C. S. P.

Provider Business Mailing Address
First Line	:	PO BOX 486
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-0486
Country	:	US
Telephone Number	:	787-791-8175
Fax Number	:	787-791-8179

Provider Business Practice Location Address
First Line	:	ISLA VERDE MALL SUITE 208
Second Line	:	6777 AVE. ISLA VERDE
City	:	CAROLINA
State	:	PR
Zip	:	00979-0000
Country	:	US
Telephone Number	:	787-791-8175
Fax Number	:	787-791-8179

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MIGUEL SEDA
Credential	:	M.D.
Telephone Number	:	787-791-8175

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	07/14/2014

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