Provider Demographics
NPI:1821502519
Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:INTEGRATE COMMUNITY HEALTH SYSTEM, INC.
Other - Org Name:METRO PAVIA CLINIC AGUADILLA - LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-230-6530
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:PMB 455
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-230-7530
Mailing Address - Fax:
Practice Address - Street 1:BARRIO CAMASEYES
Practice Address - Street 2:CARR 107
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-296-9778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D2126577291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory