Provider Demographics
NPI:1053837278
Name:BELLA VISTA HOSPITAL, INC.
Entity Type:Organization
Organization Name:BELLA VISTA HOSPITAL, INC.
Other - Org Name:BELLA VISTA ONCOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRATACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-2350
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0424
Mailing Address - Country:US
Mailing Address - Phone:787-834-2350
Mailing Address - Fax:787-805-3580
Practice Address - Street 1:CARR 349 KM 2.7
Practice Address - Street 2:CERRO LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA VISTA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty