Provider Demographics
NPI:1639696289
Name:HOSPITAL MENONITA GUAYAMA INC
Entity Type:Organization
Organization Name:HOSPITAL MENONITA GUAYAMA INC
Other - Org Name:HOSPITAL MENONITA DE GUAYAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND CODING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1714
Practice Address - Street 1:URB. LA HACIENDA ALBIZU CAMPOS
Practice Address - Street 2:ESQUINA PRINCIPAL
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0011
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-086282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400048Medicaid
PR400048Medicaid