Provider Demographics
NPI:1346322344
Name:LAB CLINICO VAN SCOY
Entity Type:Organization
Organization Name:LAB CLINICO VAN SCOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-799-0795
Mailing Address - Street 1:RR 8 BOX 1995
Mailing Address - Street 2:MSC 178
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9613
Mailing Address - Country:US
Mailing Address - Phone:787-799-0795
Mailing Address - Fax:787-799-0828
Practice Address - Street 1:CARR 167 KM 01 RAMAL 829
Practice Address - Street 2:BUENA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-799-0795
Practice Address - Fax:787-799-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR964291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031334Medicare PIN