1982785499 NPI number — ST. PETER AMBULANCE

Table of content: HANBYUL CHOI (NPI 1164885174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982785499 NPI number — ST. PETER AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. PETER AMBULANCE
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:
1982785499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARROYO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00714-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-839-4050
Provider Business Mailing Address Fax Number:
787-839-4074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 184 KM 0.8
Provider Second Line Business Practice Location Address:
BO. CACAO BAJO
Provider Business Practice Location Address City Name:
PATILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-839-4050
Provider Business Practice Location Address Fax Number:
787-839-4074
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORGE FLORES
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-839-4050

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TCAMB-332 , 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: 890563 . This is a "MMM HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7140019 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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