1841295557 NPI number — SAINT LUKES MEMORIAL HOSPITAL INC

Table of content: (NPI 1841295557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841295557 NPI number — SAINT LUKES MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT LUKES MEMORIAL HOSPITAL 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:
6
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:
1841295557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336810
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:
00733-6810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-844-2080
Provider Business Mailing Address Fax Number:
787-844-7506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 AVE TITO CASTRO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-2080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GUILLEN
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
787-844-2080

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 5 , 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: 10826 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660191960 . This is a "MAPFRE & OTHERS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 19020 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 19826 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7310370 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31225 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31247 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5501466 . This is a "ACAA ASC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 92399 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 18826 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 300115 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 304264 . This is a "ACAA TERAPIA FISICA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 18020 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4855 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 66011960B . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 700009 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31225 . This is a "TRIPLE C" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5001587 . This is a "ACAA HOSP/ER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 117499900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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