1689003576 NPI number — ADVANCED GASTROENTEROLOGY CENTER, PSC

Table of content: (NPI 1962646398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689003576 NPI number — ADVANCED GASTROENTEROLOGY CENTER, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED GASTROENTEROLOGY CENTER, 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1689003576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-679-8144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 115 KM 24.1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-679-8144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
HIRAM
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
GASTROENTEROLOGIST
Authorized Official Telephone Number:
787-529-1699

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X , with the licence number:  17586 , 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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