Provider Demographics
NPI:1255662912
Name:ULTIMATE MEDICAL CARE CSP
Entity type:Organization
Organization Name:ULTIMATE MEDICAL CARE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:BERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-450-7404
Mailing Address - Street 1:CALLE LAS MERCEDES #25
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-459-7404
Mailing Address - Fax:
Practice Address - Street 1:CALLE LAS MERCEDES #25
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-459-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16502261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1194833103Medicare NSC