1730179185 NPI number — DIABETIC CENTER & HOSPITAL SUPPLY INC

Table of content: (NPI 1730179185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730179185 NPI number — DIABETIC CENTER & HOSPITAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETIC CENTER & HOSPITAL SUPPLY 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:
Provider Other Organization Name Type Code:
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:
1730179185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-8746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-284-3997
Provider Business Mailing Address Fax Number:
787-284-3997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2743 CALLE LAS CARROZAS
Provider Second Line Business Practice Location Address:
URB PERLA DEL SUR
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-0407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-284-3997
Provider Business Practice Location Address Fax Number:
787-843-0014
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BONILLA
Authorized Official First Name:
RAMON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-284-3997

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  DI0300C , 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: 50086DI . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 990168 . This is a "MMM HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9000688 . This is a "CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com