Provider Demographics
NPI:1942219415
Name:CARIBE MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:CARIBE MEDICAL SUPPLY, INC
Other - Org Name:CARIBE MEDICAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GERENTE GENERAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISONO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-783-0815
Mailing Address - Street 1:URB CAMBRIDGE PARK
Mailing Address - Street 2:A5 AVE. CHESNUT HILL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-0001
Mailing Address - Country:US
Mailing Address - Phone:787-783-0815
Mailing Address - Fax:787-783-0840
Practice Address - Street 1:1351 CALLE ANTONIO ARROYO
Practice Address - Street 2:ESQUINA PAZ GRANELA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4223
Practice Address - Country:US
Practice Address - Phone:787-783-0815
Practice Address - Fax:787-783-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB 3303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========1OtherMCS CLASSICARE Y REFORMA
PR56811Medicare ID - Type Unspecified