Provider Demographics
NPI:1184308207
Name:MEDIC LIFE SUPPORT LLC
Entity type:Organization
Organization Name:MEDIC LIFE SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WASLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTO COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-210-1400
Mailing Address - Street 1:139 CALLE B
Mailing Address - Street 2:URB LA VEGA
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-210-1400
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 13.2 URB ORTA LOCAL NUM 5
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-210-1400
Practice Address - Fax:787-936-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport