1558589788 NPI number — EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP

Table of content: (NPI 1558589788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558589788 NPI number — EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP
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:
EDMS,CSP
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:
1558589788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ESTANCIAS DE SAN FERNANDO
Provider Second Line Business Mailing Address:
STREET #4 B-17
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00985-5213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-721-2160
Provider Business Mailing Address Fax Number:
787-722-8016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 AVE ASHFORD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-725-5613
Provider Business Practice Location Address Fax Number:
787-725-5613
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-721-2160

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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