1184686966 NPI number — MEDICAL CARE SPECIALISTS CORP.

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 1184686966 NPI number — MEDICAL CARE SPECIALISTS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CARE SPECIALISTS 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:
1184686966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1462 CALLE EDEN
Provider Second Line Business Mailing Address:
CAPARRA HEIGHTS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-706-8125
Provider Business Mailing Address Fax Number:
787-706-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONSTITUCION 403
Provider Second Line Business Practice Location Address:
PUERTO NUEVO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-781-8318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ LOPEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-706-8125

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5366430001 , 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: 5-7346-ME . This is a "TRIPLE S PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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