Provider Demographics
NPI:1306831946
Name:MEDNUR CORP
Entity Type:Organization
Organization Name:MEDNUR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURACION
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:787-882-2940
Mailing Address - Street 1:PO BOX 4789
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4789
Mailing Address - Country:US
Mailing Address - Phone:787-882-2940
Mailing Address - Fax:787-891-4146
Practice Address - Street 1:CALLE COLON # 106
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3166
Practice Address - Country:US
Practice Address - Phone:787-252-8330
Practice Address - Fax:787-252-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLIC NUM 1 CNC 00-193261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR402526Medicare Oscar/Certification