Provider Demographics
NPI:1093820086
Name:MONTEHIEDRA CT & MRI CENTER LLC
Entity Type:Organization
Organization Name:MONTEHIEDRA CT & MRI CENTER LLC
Other - Org Name:MONTEHIEDRA MRI & CT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DONATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-708-5000
Mailing Address - Street 1:MONTEHEIDRA TOWN CENTER
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-708-5000
Mailing Address - Fax:787-708-5010
Practice Address - Street 1:AVE. LOS ROMERO
Practice Address - Street 2:MONTEHIEDRA TOWN CENTER SUITE 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-705-5000
Practice Address - Fax:787-705-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0085106Medicare UPIN
85106Medicare ID - Type Unspecified