Provider Demographics
NPI:1225301641
Name:MED CENTRO, INC.
Entity Type:Organization
Organization Name:MED CENTRO, INC.
Other - Org Name:CONSEJO DE SALUD DE PUERTO RICO INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON-SALICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHCM
Authorized Official - Phone:787-843-9393
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0220
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:787-841-0077
Practice Address - Street 1:CARR 385 # KM.5
Practice Address - Street 2:CUEVAS WARD
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-7505
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED CENTRO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-15
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026172Medicare PIN