1871609610 NPI number — ENDOUROLOGICAL INSTITUTE 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 1871609610 NPI number — ENDOUROLOGICAL INSTITUTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOUROLOGICAL INSTITUTE 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:
6
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:
1871609610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 AVENIDA PONCE DE LEON
Provider Second Line Business Mailing Address:
TORRE DE AUXILIO MUTUO SUITE 608
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-777-8181
Provider Business Mailing Address Fax Number:
787-777-8180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ENDOUROLOGICAL INSTITUTE INC-CENTRO CIRUGIA AMBULATORIA
Provider Second Line Business Practice Location Address:
735 AVE PONCE DE LEON SUITE 608-612 TORRE AUXILIO MUTUO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-8181
Provider Business Practice Location Address Fax Number:
787-777-8180
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDONA DOBLE
Authorized Official First Name:
PABLO
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT ENDOUROLOGICAL INSTITUTE
Authorized Official Telephone Number:
787-777-8181

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 14 , 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)

  • Identifier: 038600400 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18038 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600226 . This is a "PREFERRED" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9170053 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 030193 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3602-2 . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00344 . This is a "AMERICAN HEALTH, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LB-45464 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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