Provider Demographics
NPI:1528201175
Name:MG ORTHOTICS AND PROSTHETICS CORP
Entity Type:Organization
Organization Name:MG ORTHOTICS AND PROSTHETICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-812-7722
Mailing Address - Street 1:530 MANSIONES DE COAMO
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-812-7722
Mailing Address - Fax:787-812-7722
Practice Address - Street 1:8155 CALLE CONCORDIA
Practice Address - Street 2:SUITE 102
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1599
Practice Address - Country:US
Practice Address - Phone:787-812-7722
Practice Address - Fax:787-812-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6307750001Medicare NSC