1477571412 NPI number — SERVICIOS MEDICOS DE ANASCO

Table of content: (NPI 1477571412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477571412 NPI number — SERVICIOS MEDICOS DE ANASCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS MEDICOS DE ANASCO
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:
1477571412
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 2002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-826-8082
Provider Business Mailing Address Fax Number:
787-826-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 402 KILOMETRO 2 BARRIO MARIAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-826-8082
Provider Business Practice Location Address Fax Number:
787-826-8082
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-826-8082

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 83347 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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