Provider Demographics
NPI:1689996647
Name:MARKAN MEDICINE CSP
Entity Type:Organization
Organization Name:MARKAN MEDICINE CSP
Other - Org Name:MARCANO AMBULATORY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARCANO-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-878-3151
Mailing Address - Street 1:PO BOX 4035
Mailing Address - Street 2:SUITE 456
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-4035
Mailing Address - Country:US
Mailing Address - Phone:787-878-3151
Mailing Address - Fax:787-880-7733
Practice Address - Street 1:115 CALLE ARIOSTO CRUZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4745
Practice Address - Country:US
Practice Address - Phone:787-878-3152
Practice Address - Fax:787-880-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSOCIAL SECURITY NUMBER