1598776189 NPI number — METROHEALTH RADIATION ONCOLOGY GROUP, INC.

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 1598776189 NPI number — METROHEALTH RADIATION ONCOLOGY GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROHEALTH RADIATION ONCOLOGY GROUP, 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:
RADIATION THERAPY AND CANCER INSTITUTE
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:
1598776189
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:
PO BOX 191625
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-774-5555
Provider Business Mailing Address Fax Number:
787-774-5767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSP. BUEN SAMARITANO, CARR. 2, KM. 141.1
Provider Second Line Business Practice Location Address:
AVE. SEVERIANO CUEVAS, BO. CAIMITAL BAJO
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-774-5555
Provider Business Practice Location Address Fax Number:
787-774-5767
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
HERIBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-774-5555

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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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