Provider Demographics
NPI:1205006814
Name:SIRTAC ENTERPRISES, INC.
Entity Type:Organization
Organization Name:SIRTAC ENTERPRISES, INC.
Other - Org Name:INNOVATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-281-7777
Mailing Address - Street 1:735 PONCE DE LEON AVE
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO SUITE 604
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-281-7777
Mailing Address - Fax:787-281-7777
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO SUITE 604
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-281-7777
Practice Address - Fax:787-281-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4145261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085180Medicare PIN