Provider Demographics
NPI:1275612780
Name:CAMUY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CAMUY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-262-1205
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0660
Mailing Address - Country:US
Mailing Address - Phone:787-262-6603
Mailing Address - Fax:787-262-1210
Practice Address - Street 1:AVENIDA MUNOZ RIVERA # 63
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0660
Practice Address - Country:US
Practice Address - Phone:787-262-6603
Practice Address - Fax:787-262-1210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMUY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR578291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031122Medicare PIN