Provider Demographics
NPI:1376168542
Name:RED MEDIC LLC
Entity Type:Organization
Organization Name:RED MEDIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO MODESTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-8092
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0080
Mailing Address - Country:US
Mailing Address - Phone:787-892-8092
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4132
Practice Address - Country:US
Practice Address - Phone:787-892-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization