MEDICARE: INVASIVE GASTRO-INTESTINAL MEDICAL SERVICE PSC

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	261QM2500X	Medical Specialty Clinic/Center	8646	PR

General Provider Information

NPI Number	:	1992932867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVASIVE GASTRO-INTESTINAL MEDICAL SERVICE PSC

Provider Business Mailing Address
First Line	:	PO BOX 800727
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-0727
Country	:	US
Telephone Number	:	787-848-7770
Fax Number	:	787-848-5818

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO STE 612
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-4722
Country	:	US
Telephone Number	:	787-848-7770
Fax Number	:	787-848-5818

Authorized Official
Title or Position	:	DOCTOR
Name	:	PEDRO F PANELLI
Credential	:	MD
Telephone Number	:	787-848-7770

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	09/16/2010

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