Provider Demographics
NPI:1992944136
Name:SOUTHERN MEDICAL IMAGING, PSC
Entity type:Organization
Organization Name:SOUTHERN MEDICAL IMAGING, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ DE LA CAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-4624
Mailing Address - Street 1:227 CALLE ISABEL
Mailing Address - Street 2:MANSION REAL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2601
Mailing Address - Country:US
Mailing Address - Phone:787-848-4624
Mailing Address - Fax:
Practice Address - Street 1:227 CALLE ISABEL
Practice Address - Street 2:MANSION REAL
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2601
Practice Address - Country:US
Practice Address - Phone:787-848-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15370207U00000X, 207UN0901X, 207UN0902X, 207UN0903X, 2085N0904X
PR2085R0001X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Multi-Specialty
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear MedicineGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty