Provider Demographics
NPI:1235133125
Name:BURGOS HOSPITAL SUPPLY INC
Entity Type:Organization
Organization Name:BURGOS HOSPITAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-288-2702
Mailing Address - Street 1:URB. SANTA MONICA A13 CALLE 13
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-1807
Mailing Address - Country:US
Mailing Address - Phone:787-288-2702
Mailing Address - Fax:787-288-2704
Practice Address - Street 1:A13 CALLE 13
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1807
Practice Address - Country:US
Practice Address - Phone:787-288-2702
Practice Address - Fax:787-288-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332BP3500X
PR05- P 1848332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0973680001Medicare NSC