1275989451 NPI number — SOUTHERN HOSPITALIST SERVICES PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275989451 NPI number — SOUTHERN HOSPITALIST SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HOSPITALIST SERVICES 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:
1275989451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 AVE TITO CASTRO
Provider Second Line Business Mailing Address:
STE 102 PMB 295
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-844-9101
Provider Business Mailing Address Fax Number:
787-651-1428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 AVE TITO CASTRO
Provider Second Line Business Practice Location Address:
STE 609 TORRE MEDICA SAN LUCAS
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-9101
Provider Business Practice Location Address Fax Number:
787-651-1428
Provider Enumeration Date:
05/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTIN
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-457-5150

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , 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)





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