1699412700 NPI number — SMART BUSINESS GROUP

Table of content: (NPI 1699412700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699412700 NPI number — SMART BUSINESS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMART BUSINESS 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:
1699412700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUIRRE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00704-0540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-410-6076
Provider Business Mailing Address Fax Number:
787-803-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 3 KM 152.1 BARRIADA LOPEZ
Provider Second Line Business Practice Location Address:
BARRIO AGUIRRE
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-410-6076
Provider Business Practice Location Address Fax Number:
787-803-9093
Provider Enumeration Date:
05/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MEDINA VAZQUEZ
Authorized Official First Name:
EMMANUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-410-6076

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 039229900 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com