MEDICARE: ALLIED SELECT MEDICAL GROUP INC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1992036974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED SELECT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 953
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687-0953
Country	:	US
Telephone Number	:	787-862-4417
Fax Number	:	787-862-7646

Provider Business Practice Location Address
First Line	:	5 CALLE BUENA VIS
Second Line	:	SUITE 1
City	:	MOROVIS
State	:	PR
Zip	:	00687-3042
Country	:	US
Telephone Number	:	787-862-4417
Fax Number	:	787-862-7646

Authorized Official
Title or Position	:	DATA ANALYST
Name	:	MR. LUIS ARIEL SANTOS AMEZAGA
Credential	:	BBA
Telephone Number	:	787-862-4417

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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Directions to “ALLIED SELECT MEDICAL GROUP INC ” Practice Location

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