1154537546 NPI number — INTEGRATE COMMUNITY HEALTH SYSTEM

Table of content: (NPI 1154537546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154537546 NPI number — INTEGRATE COMMUNITY HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATE COMMUNITY HEALTH SYSTEM
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:
METRO PAVIA CLINIC HATO REY
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:
1154537546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 CALLE CALAF STREET PMB 455
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-772-9850
Provider Business Mailing Address Fax Number:
787-274-8895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB EL VEDADO #426
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-772-9850
Provider Business Practice Location Address Fax Number:
787-274-8895
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLIVAN
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-641-4234

Provider Taxonomy Codes

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

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

  • Identifier: 1002 . This is a "LIC. LABORATORIO CLINICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 131 . This is a "LICENCIA OPERAR CDT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com