1568476539 NPI number — QUALITY HEALTH SERVICES OF PUERTO RICO INC

Table of content: CATHYANN JACKSON CRNA (NPI 1639100936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568476539 NPI number — QUALITY HEALTH SERVICES OF PUERTO RICO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY HEALTH SERVICES OF PUERTO RICO INC
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 SAN CRISTOBAL
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:
1568476539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-0501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-848-2100
Provider Business Mailing Address Fax Number:
787-848-1110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR 506 STREET
Provider Second Line Business Practice Location Address:
KM 1.0
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-0501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-2100
Provider Business Practice Location Address Fax Number:
787-848-1110
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENETTI
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR EXECUTIVE & VP
Authorized Official Telephone Number:
787-848-2100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  17 , 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)

  • Identifier: 017894600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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