1225266059 NPI number — SOUTHWEST HEALTH CORP

Table of content: (NPI 1225266059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225266059 NPI number — SOUTHWEST HEALTH CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST HEALTH CORP
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:
HOSPITAL METROPOLITANO PSIQUIATRICO DE CABO ROJO
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:
1225266059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-806-1687
Provider Business Mailing Address Fax Number:
787-806-1686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. GONZALEZ CLEMENTE #445, BO. GUANAJIBO
Provider Second Line Business Practice Location Address:
EDIF. VAL HARBOR, SUITE 105
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-806-1687
Provider Business Practice Location Address Fax Number:
787-806-1686
Provider Enumeration Date:
07/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTIZ PAGAN
Authorized Official First Name:
GIOVANNI
Authorized Official Middle Name:
EZEQUIEL
Authorized Official Title or Position:
DIRECTOR EJECUTIVO
Authorized Official Telephone Number:
787-851-2025

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  70 , 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)