Provider Demographics
NPI:1215340567
Name:PRIME MEDICA PSC
Entity type:Organization
Organization Name:PRIME MEDICA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-0345
Mailing Address - Street 1:HC 3 BOX 39603
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9794
Mailing Address - Country:US
Mailing Address - Phone:787-868-0345
Mailing Address - Fax:787-868-0345
Practice Address - Street 1:HC 3 BOX 39603
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9794
Practice Address - Country:US
Practice Address - Phone:787-868-0345
Practice Address - Fax:787-868-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care