Provider Demographics
NPI:1639316995
Name:CENTRO CIRUGIA AMBULATORIA HOSPITAL SAN ANTONIO
Entity Type:Organization
Organization Name:CENTRO CIRUGIA AMBULATORIA HOSPITAL SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-806-1118
Mailing Address - Street 1:P O BOX 546
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0546
Mailing Address - Country:US
Mailing Address - Phone:787-834-0050
Mailing Address - Fax:787-834-2104
Practice Address - Street 1:RAMON EMETERIO BETANCES 18 NORTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-0546
Practice Address - Country:US
Practice Address - Phone:787-834-0050
Practice Address - Fax:787-834-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical