Provider Demographics
NPI:1124774716
Name:PRIMARY CARE MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:PRIMARY CARE MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-275-7179
Mailing Address - Street 1:1396 CALLE SAN RAFAEL
Mailing Address - Street 2:MEDICAL PAVILION, SUITE 5
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-725-6713
Mailing Address - Fax:787-998-6733
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:MEDICAL PAVILION, SUITE 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-725-6713
Practice Address - Fax:787-998-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038331200Medicaid