Provider Demographics
NPI:1265511141
Name:MEDCO MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:MEDCO MEDICAL EQUIPMENT INC
Other - Org Name:MEDCO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ORTIZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-818-3755
Mailing Address - Street 1:PO BOX 3044
Mailing Address - Street 2:HATO ARRIBA STATION
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-818-3755
Mailing Address - Fax:787-818-3825
Practice Address - Street 1:EDIFICIO VALE COLON OFICINA #10
Practice Address - Street 2:CARR 111 KM 3.5 BO PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-3755
Practice Address - Fax:787-818-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4551660001332B00000X
PR4551660002333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4551660001Medicare ID - Type Unspecified
PR4551660002Medicare ID - Type Unspecified