Provider Demographics
NPI:1790804680
Name:SOUTHERN HOSPITAL SERVICE INC
Entity Type:Organization
Organization Name:SOUTHERN HOSPITAL SERVICE INC
Other - Org Name:CENTRO SAN CRISTOBAL VILLALBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDEVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-837-2265
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1400
Mailing Address - Country:US
Mailing Address - Phone:787-837-2265
Mailing Address - Fax:787-260-1441
Practice Address - Street 1:40 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2221
Practice Address - Country:US
Practice Address - Phone:787-847-3000
Practice Address - Fax:787-260-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCN020AOtherPTAN
PRCN020AOtherPTAN