1053300541 NPI number — PROFESSIONAL ANESTHESIA PROVIDERS PSC

Table of content: (NPI 1053300541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053300541 NPI number — PROFESSIONAL ANESTHESIA PROVIDERS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL ANESTHESIA PROVIDERS 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:
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:
1053300541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 939
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-4347
Provider Business Mailing Address Fax Number:
787-265-7750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE DE DIEGO E # 55
Provider Second Line Business Practice Location Address:
OFI 207 CPR BUILDING
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-4347
Provider Business Practice Location Address Fax Number:
787-265-7750
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECERRA
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-834-4347

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  9473 , 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: 70800051 . This is a "HUMANA INS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 84994 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 208028 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: AN2043 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 068944 . This is a "LA CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 08345 . This is a "ASOCIACION MAESTRO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 03654 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: A103 . This is a "INTERNATIONAL ME" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE4710 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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