1124598107 NPI number — BUEN SAMARITANO RADIOLOGY MEDICAL BILLING SERVICES

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 1124598107 NPI number — BUEN SAMARITANO RADIOLOGY MEDICAL BILLING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUEN SAMARITANO RADIOLOGY MEDICAL BILLING SERVICES
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:
1124598107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4055
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605-4055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-658-0000
Provider Business Mailing Address Fax Number:
787-658-0640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 AVE SEVERIANO CUEVAS BO CAIMITAL BAJO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-658-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ACOSTA
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
FISCAL SERVICE MANAGER
Authorized Official Telephone Number:
787-658-0000

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com