Provider Demographics
NPI:1477669737
Name:MEDIKO IMAGING INC.
Entity Type:Organization
Organization Name:MEDIKO IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ COSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-1563
Mailing Address - Street 1:PO BOX 8729
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8729
Mailing Address - Country:US
Mailing Address - Phone:787-743-1563
Mailing Address - Fax:787-745-9637
Practice Address - Street 1:CALLE BARBOSA
Practice Address - Street 2:#56
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-4592
Practice Address - Fax:787-738-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84327Medicare ID - Type Unspecified