1134878036 NPI number — HOSPITAL MEDCAL

Table of content: (NPI 1134878036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134878036 NPI number — HOSPITAL MEDCAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL MEDCAL
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:
1134878036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
361 FALLS RD # 70665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAFTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53024-2617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOSQUES DE SAN MIGUEL 513
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANCUN
Provider Business Practice Location Address State Name:
MEXICO
Provider Business Practice Location Address Postal Code:
77537
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
888-449-7799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHMAN
Authorized Official First Name:
IAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
331-071-5051

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MCO140922PK6 . This is a "STATE" identifier . This identifiers is of the category "OTHER".




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