Provider Demographics
NPI:1639246614
Name:MEDICOR HEALTHCARE INC
Entity Type:Organization
Organization Name:MEDICOR HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-787-5573
Mailing Address - Street 1:PO BOX 70255
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8255
Mailing Address - Country:US
Mailing Address - Phone:800-250-4468
Mailing Address - Fax:866-930-8001
Practice Address - Street 1:69-2 AVENIDA WEST MAIN SIERRA BAYAMON
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-787-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-P-2071332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57166OtherSSS PROVIDER NUMBER
PR5180380001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER