Provider Demographics
NPI:1891948436
Name:SMIS CORPORATION
Entity Type:Organization
Organization Name:SMIS CORPORATION
Other - Org Name:SANTURCE MEDICAL INTEGRATED SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONAL VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REY
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CLAUDIO-FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-726-0440
Mailing Address - Street 1:1801 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1900
Mailing Address - Country:US
Mailing Address - Phone:787-726-0440
Mailing Address - Fax:787-727-5574
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 411
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-726-0440
Practice Address - Fax:787-727-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR183001OtherCERTIFICADO DE REGISTRO DEPARTAMENTO DE ESTADO DEL ESTADO LIBRE ASOCIADO DE PR