Provider Demographics
NPI:1124222682
Name:NEOMED CENTER, INC
Entity Type:Organization
Organization Name:NEOMED CENTER, INC
Other - Org Name:NEOMED CENTER-OPD SAN LORENZO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:11 CALLE CONDADO
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4214
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84671Medicare UPIN