Provider Demographics
NPI:1215208012
Name:CENTRO MEDICO DE ESPECIALIDADES SAMANA
Entity Type:Organization
Organization Name:CENTRO MEDICO DE ESPECIALIDADES SAMANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:809-538-3888
Mailing Address - Street 1:C/O 220 EAST MONUMENT AVE. SUITE B SUITE 110
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-931-1717
Mailing Address - Fax:407-931-2121
Practice Address - Street 1:CALLE CORONEL ANDRES DIAZ NO. 6
Practice Address - Street 2:
Practice Address - City:SAMANA
Practice Address - State:SAMANA
Practice Address - Zip Code:NONE
Practice Address - Country:DO
Practice Address - Phone:809-538-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital