Provider Demographics
NPI:1437469707
Name:PR MEDICAL ORTHOTICS SERVICE CORP.
Entity Type:Organization
Organization Name:PR MEDICAL ORTHOTICS SERVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:BERNABE
Authorized Official - Last Name:BERDECIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-294-5950
Mailing Address - Street 1:P.O. BOX 56223
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0000
Mailing Address - Country:US
Mailing Address - Phone:787-294-5950
Mailing Address - Fax:787-251-8818
Practice Address - Street 1:CALLE 15 T34 FLAMBOYAN GARDENS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-294-5950
Practice Address - Fax:787-251-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6488250001Medicare NSC