Provider Demographics
NPI:1255419503
Name:MENNONITE GENERAL HOSPITAL,INC.
Entity type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-735-9206
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1379
Mailing Address - Country:US
Mailing Address - Phone:787-735-9206
Mailing Address - Fax:787-735-7150
Practice Address - Street 1:2 JOSE C VAZQUEZ ST.
Practice Address - Street 2:BOCAONILLAS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-735-9206
Practice Address - Fax:787-735-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAPM-047332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0766530001Medicare NSC