Provider Demographics
NPI:1942403779
Name:MP RADIOLOGY SERVICE CORP.
Entity Type:Organization
Organization Name:MP RADIOLOGY SERVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-272-4175
Mailing Address - Street 1:PMB 336 - 405
Mailing Address - Street 2:AVE. ESMERALDA SUITE 2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4457
Mailing Address - Country:US
Mailing Address - Phone:787-272-0668
Mailing Address - Fax:787-708-2588
Practice Address - Street 1:# 6 CARAZO STREET
Practice Address - Street 2:GUAYNABO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4457
Practice Address - Country:US
Practice Address - Phone:787-272-0668
Practice Address - Fax:787-708-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10382261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF01063Medicare UPIN