1467518340 NPI number — MED CENTRO, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467518340 NPI number — MED CENTRO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED CENTRO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONSEJO DE SALUD DE PUETRO RICO, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467518340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCEDITA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00715-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-9393
Provider Business Mailing Address Fax Number:
787-841-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 AVE HOSTOS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-9393
Provider Business Practice Location Address Fax Number:
787-841-0077
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CINTRON-SALICHS
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-843-9393

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  18-F-2860 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2086477 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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