1780770917 NPI number — SOUTHERN HEALTH CARE GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780770917 NPI number — SOUTHERN HEALTH CARE GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HEALTH CARE GROUP, INC.
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:
1780770917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1805
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYAMA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-866-1212
Provider Business Mailing Address Fax Number:
787-866-3322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOUTHERN MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
CALLE 3 NUM 80 SUR
Provider Business Practice Location Address City Name:
GUAYAMA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-866-1212
Provider Business Practice Location Address Fax Number:
787-866-3322
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
SERGIO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR MEDICO
Authorized Official Telephone Number:
787-866-1212

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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