1811771686 NPI number — PHILIPPINE MEDICAL AND DENTAL REFERRAL SERVICES LLC

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 1811771686 NPI number — PHILIPPINE MEDICAL AND DENTAL REFERRAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIPPINE MEDICAL AND DENTAL REFERRAL SERVICES LLC
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:
1811771686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 CHALAN SAN ANTONIO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96913-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-637-5433
Provider Business Mailing Address Fax Number:
671-633-5433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. LUKE'S MEDICAL CENTER GLOBAL CITY
Provider Second Line Business Practice Location Address:
32ND ST. COR 5TH AVE. BONIFACIO GLOBAL CITY
Provider Business Practice Location Address City Name:
TAGUIG
Provider Business Practice Location Address State Name:
PHILIPPINES
Provider Business Practice Location Address Postal Code:
163444
Provider Business Practice Location Address Country Code:
PH
Provider Business Practice Location Address Telephone Number:
632-789-7700
Provider Business Practice Location Address Fax Number:
632-789-7700
Provider Enumeration Date:
08/23/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCES
Authorized Official First Name:
ANNA LOU
Authorized Official Middle Name:
CARANAY
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
671-489-5433

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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