1700891439 NPI number — MEDICAL FAMILY PRACTICE CTR CSP

Table of content: (NPI 1700891439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700891439 NPI number — MEDICAL FAMILY PRACTICE CTR CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL FAMILY PRACTICE CTR CSP
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:
Provider Other Organization Name Type Code:
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:
1700891439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142529
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-2529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-817-0573
Provider Business Mailing Address Fax Number:
787-816-0219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G5 CALLE MARGINAL
Provider Second Line Business Practice Location Address:
URB VISTA AZUL
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-817-0573
Provider Business Practice Location Address Fax Number:
787-816-0219
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINO
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-817-0573

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  12748 , 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: 1700891439 . This is a "CHAMPVA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "MAPFRE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "MAPFRE MEDICARE EXCEL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 84396 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "MMM HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "AARP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: DU442A . This is a "MEDICARE PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "AMPR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "TRICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 16098 . This is a "AHM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "GLOBAL HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700891439 . This is a "MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com