Provider Demographics
NPI:1093855041
Name:SOUTHERN HOSPITAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN HOSPITAL SERVICES
Other - Org Name:CENTRO SAN CRISTOBAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7878-372-2654
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1400
Mailing Address - Country:US
Mailing Address - Phone:787-837-2265
Mailing Address - Fax:787-260-1441
Practice Address - Street 1:45 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3043
Practice Address - Country:US
Practice Address - Phone:787-847-3000
Practice Address - Fax:787-847-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1847302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCN020AOtherPTAN
PRCN020AOtherPTAN