Provider Demographics
NPI:1396813549
Name:SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC.
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC.
Other - Org Name:ATLANTIC MEDICAL CENTER - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAZARIO LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-846-4412
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2045
Mailing Address - Country:US
Mailing Address - Phone:787-846-4412
Mailing Address - Fax:787-846-7410
Practice Address - Street 1:CARR #2 KIL 57.8
Practice Address - Street 2:CRUCE DAVILA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2045
Practice Address - Country:US
Practice Address - Phone:787-846-4412
Practice Address - Fax:787-846-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR985Medicaid