Provider Demographics
NPI:1710980925
Name:MD RADIOLOGY SERVICES PSC
Entity Type:Organization
Organization Name:MD RADIOLOGY SERVICES PSC
Other - Org Name:CENTRO MEDICO PROFESIONAL DE LA SALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-859-4443
Mailing Address - Street 1:HC 02 BOX 9950
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-4443
Mailing Address - Fax:787-792-7598
Practice Address - Street 1:CARRETERA 891 KM 15.1
Practice Address - Street 2:BO PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9509
Practice Address - Country:US
Practice Address - Phone:787-859-4443
Practice Address - Fax:787-792-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR337291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30969Medicare PIN