Provider Demographics
NPI:1558614362
Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC
Other - Org Name:METRO PAVIA CLINIC BAYAMON LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-234-8865
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:PMB 455
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-772-9850
Mailing Address - Fax:787-641-4240
Practice Address - Street 1:77 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6935
Practice Address - Country:US
Practice Address - Phone:787-772-9850
Practice Address - Fax:787-641-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory