1417050519 NPI number — ORTHOPAEDIXSPSC

Table of content: (NPI 1417050519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417050519 NPI number — ORTHOPAEDIXSPSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIXSPSC
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:
OTHOPAEDIXSPSC
Provider Other Organization Name Type Code:
4
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:
1417050519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 787
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-0787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-4040
Provider Business Mailing Address Fax Number:
787-854-4770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZAPUERTA DEL SOL NUM 54
Provider Second Line Business Practice Location Address:
LOCAL 14
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-4040
Provider Business Practice Location Address Fax Number:
787-854-3030
Provider Enumeration Date:
09/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARRION
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
I
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
17878544040

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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