Provider Demographics
NPI:1184668592
Name:EQUIPOS MEDICOS DE LA MONTANA, INC.
Entity Type:Organization
Organization Name:EQUIPOS MEDICOS DE LA MONTANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:DELIA
Authorized Official - Last Name:VIRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-859-2913
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0617
Mailing Address - Country:US
Mailing Address - Phone:787-859-2913
Mailing Address - Fax:787-859-2906
Practice Address - Street 1:CARR. 891 KM 15.0
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-2913
Practice Address - Fax:787-859-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5194480001Medicare NSC