1275726408 NPI number — RADIO SURGERY GROUP

Table of content: (NPI 1275726408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275726408 NPI number — RADIO SURGERY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIO SURGERY GROUP
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:
1275726408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8043
Provider Second Line Business Mailing Address:
MARINA STATION
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-8043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-6070
Provider Business Mailing Address Fax Number:
787-834-5535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSP. DR. RAMON EMETERIO BETANCES
Provider Second Line Business Practice Location Address:
ROAD #2 AVE. HOSTOS #410
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-6070
Provider Business Practice Location Address Fax Number:
787-834-5535
Provider Enumeration Date:
08/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
RADIATION-ONCOLOGIST
Authorized Official Telephone Number:
787-834-6070

Provider Taxonomy Codes

  • Taxonomy code: 2471R0002X , with the licence number:  12829 , 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)