Provider Demographics
NPI:1699224337
Name:MENNONITE GENERAL HOSPITAL INC.
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL INC.
Other - Org Name:CENTRO DE SALUD CONDUCTUAL MENONITA CIMA CAGUAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING 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:F35 CALLE 2
Mailing Address - Street 2:URB BONN TERRACE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0000
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1714
Practice Address - Street 1:AVENIDA JOSE GAUTIER BENITEZ, NUMERO 230 BO. PUEBLO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-296-9776
Practice Address - Fax:787-735-3749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404009Medicare UPIN