1598143513 NPI number — WEST SPINE P.S.C

Table of content: (NPI 1598143513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598143513 NPI number — WEST SPINE P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST SPINE P.S.C
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:
DR. JOSE NEGRON
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:
1598143513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1861
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-292-3119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 AVE HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 302B
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-292-3119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEGRON
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
939-292-3119

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  501 , 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)