Provider Demographics
NPI:1093357337
Name:NEOMED CENTER, INC.
Entity Type:Organization
Organization Name:NEOMED CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO-AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-737-2311
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1278
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-2377
Practice Address - Street 1:STREET #31 KM 3.7
Practice Address - Street 2:LOT #2
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOMED CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)