Provider Demographics
NPI:1528558129
Name:MENNONITE GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL INC
Other - Org Name:CENTRO RADIOLOGICO HOSPITAL MENONITA, OROCOVIS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-0550
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1714
Practice Address - Street 1:18 AVENIDA LUIS MUNOZ MARIN
Practice Address - Street 2:EDIFICIO ORO OFFICE
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-0000
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE GENERAL HOSPITAL,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid