Provider Demographics
NPI:1801867635
Name:NORTH SHORE ORTHOPAEDICS, PSC
Entity Type:Organization
Organization Name:NORTH SHORE ORTHOPAEDICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-882-5100
Mailing Address - Street 1:PO BOX 5221
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5221
Mailing Address - Country:US
Mailing Address - Phone:787-882-5100
Mailing Address - Fax:787-882-5140
Practice Address - Street 1:18 AVE. SEVERIANO CUEVAS
Practice Address - Street 2:HOSP. BUEN SAMARITANO SUITE 100
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-5100
Practice Address - Fax:787-882-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15174207X00000X, 207XS0106X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Not Answered207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-24662Medicare UPIN