Provider Demographics
NPI:1497828289
Name:MEDSCAN
Entity Type:Organization
Organization Name:MEDSCAN
Other - Org Name:MEDSCAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-3010
Mailing Address - Street 1:PO BOX 29460
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0460
Mailing Address - Country:US
Mailing Address - Phone:787-740-3010
Mailing Address - Fax:787-740-3009
Practice Address - Street 1:A8 AVE 65 INFANTERIA
Practice Address - Street 2:URB SAN AGUSTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1834
Practice Address - Country:US
Practice Address - Phone:787-207-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR141642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH46747Medicare UPIN