Provider Demographics
NPI:1922333145
Name:FIRST HOSPTIAL PANAMERICANO
Entity Type:Organization
Organization Name:FIRST HOSPTIAL PANAMERICANO
Other - Org Name:PARCIAL DE MAYAGUEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-739-5555
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1400
Mailing Address - Country:US
Mailing Address - Phone:787-739-5555
Mailing Address - Fax:787-739-0035
Practice Address - Street 1:WESTERN INDUSTRIAL PARK
Practice Address - Street 2:ROSHELISE CENTER SUITE 301
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-739-5555
Practice Address - Fax:787-739-0035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANAMERICANO MAYAGUEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97 CNC 911173261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404004Medicare PIN