1790804680 NPI number — SOUTHERN HOSPITAL SERVICE INC

Table of content: (NPI 1790804680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790804680 NPI number — SOUTHERN HOSPITAL SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HOSPITAL SERVICE 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:
CENTRO SAN CRISTOBAL VILLALBA
Provider Other Organization Name Type Code:
3
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:
1790804680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUANA DIAZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00795-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-837-2265
Provider Business Mailing Address Fax Number:
787-260-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLALBA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00766-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-847-3000
Provider Business Practice Location Address Fax Number:
787-260-1441
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLDEVILA
Authorized Official First Name:
FRANCO
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
787-837-2265

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CN020A . This is a "PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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