Provider Demographics
NPI:1659048338
Name:MEDCO LLC
Entity Type:Organization
Organization Name:MEDCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:CORDERO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-237-5901
Mailing Address - Street 1:PO BOX 3085
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3085
Mailing Address - Country:US
Mailing Address - Phone:787-237-5901
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL WILMA N VAZQUEZ CAR #2 KM 39.5
Practice Address - Street 2:SUITE 104
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0069
Practice Address - Country:US
Practice Address - Phone:787-237-5901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health