1396041653 NPI number — TOTALMED SUBIC CORPORATION

Table of content: (NPI 1396041653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396041653 NPI number — TOTALMED SUBIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTALMED SUBIC CORPORATION
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:
1396041653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TOTALMED SUBIC CORP GATEWAY PARK #2 BRAVEHEART STREET
Provider Second Line Business Mailing Address:
SUBIC BAY FREEPORT
Provider Business Mailing Address City Name:
OLONGAPO CITY
Provider Business Mailing Address State Name:
ZAMBALES
Provider Business Mailing Address Postal Code:
2222
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
47-252-2623
Provider Business Mailing Address Fax Number:
47-252-8747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TOTALMED SUBIC CORP GATEWAY PARK #2 BRAVEHEART STREET
Provider Second Line Business Practice Location Address:
SUBIC BAY FREEPORT
Provider Business Practice Location Address City Name:
OLONGAPO CITY
Provider Business Practice Location Address State Name:
ZAMBALES
Provider Business Practice Location Address Postal Code:
2222
Provider Business Practice Location Address Country Code:
PH
Provider Business Practice Location Address Telephone Number:
47-252-2623
Provider Business Practice Location Address Fax Number:
47-252-8747
Provider Enumeration Date:
02/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RICARDO
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
47-252-2623

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  261Q00000X2011 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHL043821PHL . This is a "TRICARE OVERSEAS" identifier . This identifiers is of the category "OTHER".




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