Provider Demographics
NPI:1023017266
Name:EDGARDO R RICHIEZ COLON
Entity Type:Organization
Organization Name:EDGARDO R RICHIEZ COLON
Other - Org Name:RICHIEZ AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHIEZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-856-3713
Mailing Address - Street 1:PO BOX 3020
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3020
Mailing Address - Country:US
Mailing Address - Phone:787-856-3713
Mailing Address - Fax:787-856-3713
Practice Address - Street 1:BARRIADA LLUBERAS EL PARALELO CARR 376 K2 HM 1
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB104341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
53535OtherSSS-REFORMA
890017OtherMMM HEALTHCARE
PR59361Medicare PIN