1245751171 NPI number — THE VOICE AND HEAD & NECK SURGERY INSTITUTE, PSC

Table of content: (NPI 1245751171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245751171 NPI number — THE VOICE AND HEAD & NECK SURGERY INSTITUTE, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VOICE AND HEAD & NECK SURGERY INSTITUTE, 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:
1245751171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 CARR 693
Provider Second Line Business Mailing Address:
PMB 384
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-621-4816
Provider Business Mailing Address Fax Number:
787-621-4817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MANATI MEDICAL CENTER PROFESSIONAL PLAZA SUITE 512
Provider Second Line Business Practice Location Address:
CALLE HERNANDEZ CARRION
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-621-4816
Provider Business Practice Location Address Fax Number:
787-621-4917
Provider Enumeration Date:
06/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO BEAUCHAMP
Authorized Official First Name:
YAMIL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-621-4816

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  18856 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 18258 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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