Provider Demographics
NPI:1114197209
Name:ASOCIACION MEDICOS DE LA MONTANA INC
Entity Type:Organization
Organization Name:ASOCIACION MEDICOS DE LA MONTANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ CALDERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-859-1901
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0620
Mailing Address - Country:US
Mailing Address - Phone:787-859-1901
Mailing Address - Fax:787-859-1901
Practice Address - Street 1:CALLE LAS MERCEDES #23
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0000
Practice Address - Country:US
Practice Address - Phone:787-859-1901
Practice Address - Fax:787-859-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRIPA932302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization