Provider Demographics
NPI:1609106566
Name:I H S CORPORATION
Entity Type:Organization
Organization Name:I H S CORPORATION
Other - Org Name:LABORATORIO CLINICO MEDIA LUNA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALOMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-794-3939
Mailing Address - Street 1:CALLE PETIROJO 784
Mailing Address - Street 2:MONTE BELLO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3628
Mailing Address - Country:US
Mailing Address - Phone:787-951-8768
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA PRINCIPAL 865 KM 1.3
Practice Address - Street 2:P 238 BO. CAMPANILLAS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-951-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D1107086291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D1107086OtherCLIA LABORATORY PROGRAM
PR039130900Medicaid