Provider Demographics
NPI:1013140383
Name:MAYAGUEZ MEDICAL CENTER DR RAMON EMETERIO BETANCES INC
Entity Type:Organization
Organization Name:MAYAGUEZ MEDICAL CENTER DR RAMON EMETERIO BETANCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-652-9200
Mailing Address - Street 1:AVE, HOSTOS #410
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1838
Mailing Address - Country:US
Mailing Address - Phone:787-652-9200
Mailing Address - Fax:
Practice Address - Street 1:AVE HOSTOS
Practice Address - Street 2:#410
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-652-9200
Practice Address - Fax:787-652-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-0103Medicare PIN