Provider Demographics
NPI:1427351774
Name:FR-MO MEDICAL GROUP PSC
Entity type:Organization
Organization Name:FR-MO MEDICAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-359-2516
Mailing Address - Street 1:CALLE 1 K1
Mailing Address - Street 2:MANSIONES DE VILLA NOVA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:787-395-7085
Mailing Address - Fax:787-395-7090
Practice Address - Street 1:METRO MEDICAL CENTER
Practice Address - Street 2:SUITE 701 PISO 7
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00956
Practice Address - Country:UM
Practice Address - Phone:787-395-7085
Practice Address - Fax:787-395-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14159207RH0003X
PR13326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI25558Medicare UPIN
PRI50793Medicare UPIN