1568452951 NPI number — ASHFORD MEDICAL CENTER RADIOLOGY OFFICES 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 1568452951 NPI number — ASHFORD MEDICAL CENTER RADIOLOGY OFFICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHFORD MEDICAL CENTER RADIOLOGY OFFICES 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:
ASHFORD MED CTR RADIOLOGY
Provider Other Organization Name Type Code:
5
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:
1568452951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 CALLE WASHINGTON
Provider Second Line Business Mailing Address:
STE 501
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-725-5955
Provider Business Mailing Address Fax Number:
787-722-7847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 AVE ASHFORD
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT 1ST FLOOR OF ASHFORD PRESBYTERIAN
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:
787-725-5955
Provider Business Practice Location Address Fax Number:
787-722-7847
Provider Enumeration Date:
10/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANDRON
Authorized Official First Name:
TERESITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-725-5955

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 84399 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 050860 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".