Provider Demographics
NPI:1568782498
Name:SOUTHWEST HEALTH CORP
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH CORP
Other - Org Name:CIRUGIA AMBULATORIA METROPOLITANO ARECIBO
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-650-0090
Mailing Address - Street 1:PO BOX 9976
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9976
Mailing Address - Country:US
Mailing Address - Phone:787-650-0090
Mailing Address - Fax:787-650-0098
Practice Address - Street 1:CARR 129 INT
Practice Address - Street 2:VICTOR ROJAS 2
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-0020
Practice Address - Fax:787-650-0100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTH CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40OtherSTATE LICENSE