1811206154 NPI number — WEST MEDICAL INTEGRATED SERVICES, PSC

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 1811206154 NPI number — WEST MEDICAL INTEGRATED SERVICES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST MEDICAL INTEGRATED SERVICES, PSC
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:
1811206154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 72 BOX 1503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-479-7767
Provider Business Mailing Address Fax Number:
787-254-1920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 101 KM 16.2
Provider Second Line Business Practice Location Address:
LAS ARENAS
Provider Business Practice Location Address City Name:
BOQUERON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-255-2775
Provider Business Practice Location Address Fax Number:
787-254-1920
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARIANI
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-479-7767

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  15181 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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