Provider Demographics
NPI:1932478344
Name:MEDICAL ANXILLARY AND EXTENDED SERVICES
Entity Type:Organization
Organization Name:MEDICAL ANXILLARY AND EXTENDED SERVICES
Other - Org Name:MAES DEVELOPMENT INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PADILLA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-5704
Mailing Address - Street 1:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1096
Mailing Address - Country:US
Mailing Address - Phone:787-854-5704
Mailing Address - Fax:787-854-5704
Practice Address - Street 1:J23 CALLE ELLIOT VELEZ
Practice Address - Street 2:SUITE 205
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-5704
Practice Address - Fax:787-854-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0088748Medicare UPIN