1114033560 NPI number — CARIBBEAN MEDICAL TESTING CENTER

Table of content: (NPI 1114033560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114033560 NPI number — CARIBBEAN MEDICAL TESTING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBBEAN MEDICAL TESTING CENTER
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:
1114033560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 192071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-754-6868
Provider Business Mailing Address Fax Number:
787-274-9280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CLEMSON ST
Provider Second Line Business Practice Location Address:
UNIVERSITY GARDENS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-6868
Provider Business Practice Location Address Fax Number:
787-274-9280
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALE
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-754-6868

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  67 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 492 , 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: 00 . This is a "MCS COMERCIAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30459 . This is a "SSS MEDICARE OPTIMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20326 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800461 . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00 . This is a "FIRST PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: R58627260 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20308L . This is a "AMERICAN HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30459 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9270096 . This is a "HUMANA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1313 . This is a "APS" identifier . This identifiers is of the category "OTHER".




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