1992944136 NPI number — SOUTHERN MEDICAL IMAGING, PSC

Table of content: (NPI 1992944136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992944136 NPI number — SOUTHERN MEDICAL IMAGING, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MEDICAL IMAGING, PSC
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:
ADRIAN A. ALVAREZ DE LA CAMPA, PSC
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:
1992944136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 CALLE ISABEL
Provider Second Line Business Mailing Address:
MANSION REAL
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-848-4624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 CALLE ISABEL
Provider Second Line Business Practice Location Address:
MANSION REAL
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-4624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALVAREZ DE LA CAMPA
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-848-4624

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X , with the licence number:  15370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207UN0901X , with the licence number: 15370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0902X , with the licence number: 15370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0903X , with the licence number: 15370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: 15370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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