Provider Demographics
NPI:1467518340
Name:MED CENTRO, INC.
Entity Type:Organization
Organization Name:MED CENTRO, INC.
Other - Org Name:CONSEJO DE SALUD DE PUETRO RICO, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON-SALICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, HHCM
Authorized Official - Phone:787-843-9393
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0220
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:787-841-0077
Practice Address - Street 1:1034 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1115
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-841-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-28603336C0003X
3336C0004X, 3336M0003X
PR11F01063336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086477OtherPK