Provider Demographics
NPI:1477580678
Name:RINCON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:RINCON MEDICAL CENTER INC
Other - Org Name:RINCON MEDICAL CENTER INC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-316-1212
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-823-0909
Mailing Address - Fax:787-915-7597
Practice Address - Street 1:115 CARRETERA PUEBLO KM 13.1
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-823-0909
Practice Address - Fax:787-915-7597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RINCON MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-26
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1084291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031520Medicare PIN