Provider Demographics
NPI:1588040281
Name:MELENDEZ GASTROENTEROLOGY INSTITUTE, LLC
Entity Type:Organization
Organization Name:MELENDEZ GASTROENTEROLOGY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MELENDEZ HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-308-6859
Mailing Address - Street 1:4246 CARRETERA 2 KM 43
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4128
Mailing Address - Country:US
Mailing Address - Phone:787-884-7218
Mailing Address - Fax:
Practice Address - Street 1:4246 CARRETERA 2 KM 43
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4128
Practice Address - Country:US
Practice Address - Phone:787-884-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16955207RG0100X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Single Specialty