Provider Demographics
NPI:1659595676
Name:METRO PAVIA HEALTHCARE CENTER
Entity Type:Organization
Organization Name:METRO PAVIA HEALTHCARE CENTER
Other - Org Name:METRO PAVIA CLINIC ARECIBO - DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-650-7294
Mailing Address - Street 1:PO BOX 9976
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9976
Mailing Address - Country:US
Mailing Address - Phone:787-650-0020
Mailing Address - Fax:787-274-8895
Practice Address - Street 1:CARR 129 VICTOR ROJAS 2
Practice Address - Street 2:ZONA INDUSTRIAL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-0020
Practice Address - Fax:787-274-8895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTH CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2655261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR043141OtherPROVIDER BLUE CROSS
PR=========OtherPROVIDER NUMBER