1760846448 NPI number — FIRST HEALTH SYSTEM, INC.

Table of content: (NPI 1760846448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760846448 NPI number — FIRST HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST HEALTH SYSTEM, 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:
FHS CIDRA
Provider Other Organization Name Type Code:
5
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:
1760846448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 CALLE 2 STE 520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968-1750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-622-9797
Provider Business Mailing Address Fax Number:
844-226-1440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CALLE ROMAN BALDORIOTY DE CASTRO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIDRA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-247-9542
Provider Business Practice Location Address Fax Number:
787-434-0317
Provider Enumeration Date:
04/08/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYES AVILES
Authorized Official First Name:
HUARALI
Authorized Official Middle Name:
Authorized Official Title or Position:
FHS GOVERNMENT HEALTH PLAN
Authorized Official Telephone Number:
787-622-9797

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)