Provider Demographics
NPI:1407869837
Name:ECHO MED VASCULAR
Entity Type:Organization
Organization Name:ECHO MED VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-649-8787
Mailing Address - Street 1:B13 CALLE DA VINCI
Mailing Address - Street 2:QUINTAS DE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7613
Mailing Address - Country:US
Mailing Address - Phone:787-649-8787
Mailing Address - Fax:787-746-4954
Practice Address - Street 1:78 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5632
Practice Address - Country:US
Practice Address - Phone:787-649-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR220371OtherPREFERED HEALTH
PR890376OtherMEDICARE Y MUCHO MAS
PR9690105OtherHUMANA
PR3830BOtherPMC
PR=========OtherMCS CLASIC CARE
PR=========OtherHUMANA GOLD PLUS
PR0020607Medicare ID - Type Unspecified