Provider Demographics
NPI:1164403903
Name:PK INDUSTRIES CORP
Entity Type:Organization
Organization Name:PK INDUSTRIES CORP
Other - Org Name:MEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:INFANZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-798-2500
Mailing Address - Street 1:3 AVE RUIZ SOLER
Mailing Address - Street 2:JARDINES DE CAPARRA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7841
Mailing Address - Country:US
Mailing Address - Phone:787-798-2500
Mailing Address - Fax:787-787-4296
Practice Address - Street 1:3 AVE RUIZ SOLER
Practice Address - Street 2:JARDINES DE CAPARRA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7841
Practice Address - Country:US
Practice Address - Phone:787-798-2500
Practice Address - Fax:787-787-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 335E00000X
PR04-P-1951332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0481730001Medicare NSC