Provider Demographics
NPI:1598057374
Name:AGUADA MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:AGUADA MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-589-7400
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-589-7400
Mailing Address - Fax:787-589-7402
Practice Address - Street 1:CARRETERA 115
Practice Address - Street 2:KM 24.5 BARRIO ASOMANTE
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-0345
Practice Address - Fax:787-868-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207PE0004X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEMPLOYER IDENTIFICATION NUMBER