Provider Demographics
NPI:1558535849
Name:J A T MEDICAL SERVICE PSC
Entity Type:Organization
Organization Name:J A T MEDICAL SERVICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-816-1028
Mailing Address - Street 1:PO BOX 2512
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2512
Mailing Address - Country:US
Mailing Address - Phone:787-816-1028
Mailing Address - Fax:787-816-1028
Practice Address - Street 1:CARR 638 KM 6.0
Practice Address - Street 2:BARRIO MIRAFLORES
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-1028
Practice Address - Fax:787-816-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12050261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40286Medicare UPIN
PR87973Medicare UPIN