Provider Demographics
NPI:1023002607
Name:MACRO ORTHOPEDIC CORP
Entity Type:Organization
Organization Name:MACRO ORTHOPEDIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-2027
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1659
Mailing Address - Country:US
Mailing Address - Phone:787-270-2027
Mailing Address - Fax:787-270-2027
Practice Address - Street 1:CARR NO 2 KM 29.7
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-1659
Practice Address - Country:US
Practice Address - Phone:787-270-2027
Practice Address - Fax:787-270-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR610405332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5058840001Medicare ID - Type Unspecified