1164417168 NPI number — CARIBE PATHOLOGY CSP

Table of content: (NPI 1164417168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164417168 NPI number — CARIBE PATHOLOGY CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBE PATHOLOGY CSP
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:
1164417168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-1021
Provider Business Mailing Address Fax Number:
787-834-1051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 349 KM. 2.7 CERRO LAS MESAS
Provider Second Line Business Practice Location Address:
HOSPITAL BELLA VISTA
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-1021
Provider Business Practice Location Address Fax Number:
787-834-1051
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEJIAS
Authorized Official First Name:
IVETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
787-834-1021

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 100041 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20170 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5106085 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 601098 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE4613 . This is a "PAN AMERICAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 221055 . This is a "PREFERRED UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6800165 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5618 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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