Provider Demographics
NPI:1821546458
Name:MENNONITE GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL, INC
Other - Org Name:CENTRO DE CUIDADO DE ULCERA Y QUEMADURAS MENONITA
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
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1714
Practice Address - Street 1:PR STATE ROAD 908 KM 0.4
Practice Address - Street 2:BARRIO TEJAS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0000
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE GENERAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400018Medicare Oscar/Certification