Provider Demographics
NPI:1609969286
Name:MIGRANT HEALTH CENTER WESTERN REGION,INC
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER WESTERN REGION,INC
Other - Org Name:MIGRANT HEALTH CENTER WESTERN REGION,INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-613-6918
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0190
Mailing Address - Country:US
Mailing Address - Phone:787-805-2920
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:CALLE RAMON EMETERIO BETANCES
Practice Address - Street 2:SUR 392
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-802-2920
Practice Address - Fax:787-834-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
PR06148261QM1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherNUMERO PATRONAL
PR0082212Medicare ID - Type UnspecifiedMEDICARE
PR0030983Medicare ID - Type UnspecifiedMEDICARE LAB