Provider Demographics
NPI:1235265927
Name:RG PROSTHETICS MFG. CORP
Entity Type:Organization
Organization Name:RG PROSTHETICS MFG. CORP
Other - Org Name:RG PROSTHETICS MFG. CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:RAMOS-MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BOC, ABC
Authorized Official - Phone:787-887-1501
Mailing Address - Street 1:PO BOX 43001
Mailing Address - Street 2:DPTO. 407
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6600
Mailing Address - Country:US
Mailing Address - Phone:787-887-1501
Mailing Address - Fax:787-888-6111
Practice Address - Street 1:LOCAL KK-59 CENTRO COMERCIAL
Practice Address - Street 2:ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-1501
Practice Address - Fax:787-888-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0847860001Medicare ID - Type UnspecifiedPROVIDER NUMBER