1881889947 NPI number — OCEANSIDE MEDICAL SERVICES CORP

Table of content: JOHN HOWARD BURGESS MD (NPI 1104908318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881889947 NPI number — OCEANSIDE MEDICAL SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEANSIDE MEDICAL SERVICES CORP
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:
1881889947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3107 CALLE BERMUDA
Provider Second Line Business Mailing Address:
UBR ISLAZUL
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-6354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-830-5914
Provider Business Mailing Address Fax Number:
787-877-2145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO PLAZA DEL MAR CARR 459 KM 11.4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-830-5914
Provider Business Practice Location Address Fax Number:
787-877-2145
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA
Authorized Official First Name:
IBELITH
Authorized Official Middle Name:
Authorized Official Title or Position:
DUENO
Authorized Official Telephone Number:
787-830-5914

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  16169 , 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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