Provider Demographics
NPI:1639518095
Name:CHAMPI MEDICAL AND WELLNESS GROUP
Entity Type:Organization
Organization Name:CHAMPI MEDICAL AND WELLNESS GROUP
Other - Org Name:CHAMPI MEDICAL AND WELLNESS GROUP, CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MACHADO-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-229-1223
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0619
Mailing Address - Country:US
Mailing Address - Phone:787-229-1223
Mailing Address - Fax:787-229-1332
Practice Address - Street 1:107 CALLE MARIA MONAGAS LOCAL #1
Practice Address - Street 2:ESQUINA 65 INFANTERIA
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-229-1223
Practice Address - Fax:787-229-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103G00000X, 103TC0700X, 133N00000X, 163WW0000X, 173C00000X, 208D00000X, 225700000X, 261Q00000X, 261QM0801X, 261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHR692AMedicare PIN